The impact of ultrasound-guided erector spinae plane block on hemodynamic stability and postoperative pain in patients undergoing modified radical mastectomy for breast cancer

OBJECTIVE

Breast cancer, a prevalent global malignancy in women, necessitates a comprehensive treatment approach, with surgery playing a crucial role. Severe acute pain is common post-radical breast cancer surgery, emphasizing the significance of hemodynamic stability and postoperative pain control for optimal outcomes. This study evaluates the impact of ultrasound-guided erector spinae plane block (ESPB) on these parameters in ASA scores 1-2 patients undergoing modified radical breast cancer surgery with general anesthesia.

PATIENTS AND METHODS

Forty-eight patients were divided into two groups: a general anesthesia group, with erector spinae plane block (GA+ESPB), and a control group receiving only general anesthesia (GA). Hemodynamic parameters were continuously monitored, and postoperative pain was assessed using the visual analog scale (VAS) at various time points.

RESULTS

Ultrasound-guided ESPB effectively maintained hemodynamic stability and reduced postoperative pain in breast cancer surgery patients. Statistically significant differences were observed in heart rate, systolic and diastolic blood pressure, and mean arterial pressure between the GA and GA+ESPB groups at multiple time points (p < 0.05). VAS scores showed a significant interaction time*group (p < 0.001), with consistent differences between the groups at all time points (p ≤ 0.001).

CONCLUSIONS

Ultrasound-guided ESPB application proved effective in preserving hemodynamic stability and managing postoperative pain in modified radical breast cancer surgery. The technique demonstrates promise in minimizing complications related to hemodynamic variations and postoperative pain, contributing to a comprehensive approach to breast cancer surgical treatment.

Ultrasound assessment of cervical status compared to the Bishop score - predicting the success of labor induction using a machine learning-based model

OBJECTIVE

The main aim of this study was to develop a machine-learning-based model for predicting the success of labor induction (IOL). To that end, the clinical and ultrasound parameters that affect the successfulness of labor induction were assessed. Then, a new ultrasound scoring system (USS) was developed and assessed.

PATIENTS AND METHODS

This prospective observational study included 192 term women who underwent induction of labor. First, a wide range of clinical and ultrasound pre-induction parameters were recorded. The induction was initiated by endocervical administration of dinoprostone gel (for Bishop score ≤5) or intravenous oxytocin (for Bishop score ≥6). After evaluating ultrasound parameters, we created an ultrasound scoring system and compared it with the Bishop score and clinical parameters. Finally, a comprehensive model using machine learning algorithms for predicting the success of the induction of labor was developed.

RESULTS

In terms of clinical parameters, this study found that IOL correlates with parity, body mass index (BMI) (both at p<0.05), and the Bishop score (p<0.001). All ultrasound parameters were statistically significant (p<0.05) apart from the posterior cervical angle. However, compared to the Bishop score, the new USS showed a slightly lower sensitivity (0.55 compared to 0.64) but much higher specificity (0.75 compared to 0.44) at a cut-off of 1.66. The proposed model, which can predict 83% of the events correctly, encompasses the Bishop score, USS, and clinical parameters.

CONCLUSIONS

The findings imply that the model developed in this study, which takes into account clinical parameters (parity, BMI), the ultrasound parameters and the Bishop score and uses machine learning algorithms, yields better results than models using other parameters.

Imported parasitic infections in Serbia

BACKGROUND

Travel to the tropics is associated with a risk of parasitic infection, which is increasing in parallel with the rise in travel to these areas. We thus examined the prevalence and trend in the occurrence of parasitic infections in Serbian travelers.

METHODS

A retrospective analysis of the medical records of all travelers returning from tropical and subtropical areas, who presented at the Institute for Infectious and Tropical Diseases in Belgrade between January 2001 and January 2008, was performed.

RESULTS

Of a total of 2440 travelers, 169 (6.9%) were diagnosed with a parasitic infection, including malaria in 79, intestinal parasites in 84 (pathogenic species in 30 and non-pathogenic in 54), filariasis in four, and visceral leishmaniasis and fascioliasis in one patient each. Importantly, of the whole series only 583 (23.9%) were symptomatic, of which 19.4% were found to be infected with a parasite. The single pathogenic parasite occurring in asymptomatic patients was Giardia intestinalis.

CONCLUSIONS

Parasitic infection causing symptomatic disease among travelers returning from tropical areas to Serbia is not infrequent. In view of the expected increase in travel to the tropics, diagnostic protocols for tropical parasitic diseases should take these data into account.

Human giardiasis in Serbia: asymptomatic vs symptomatic infection

Despite the public health importance of giardiasis in all of Europe, reliable data on the incidence and prevalence in Western Balkan Countries (Serbia, Bosnia and Herzegovina, Croatia, Montenegro and FYR Macedonia) are scarce, and the relative contribution of waterborne and food-borne, or person-to-person and/or animal-to-person, transmission of human giardiasis is not yet clear. To provide baseline data for the estimation of the public health risk caused by Giardia, we here review the information available on the epidemiological characteristics of asymptomatic and symptomatic human infection in Serbia. Although asymptomatic cases of Giardia represent a major proportion of the total cases of infection, high rates of Giardia infection were found in both asymptomatic and symptomatic populations. No waterborne outbreaks of giardiasis have been reported, and it thus seems that giardiasis mostly occurs sporadically in our milieu. Under such circumstances, control measures to reduce the high prevalence of giardiasis in Serbia have focused on person-to-person transmission, encouraging proper hygiene, but for more targeted intervention measures, studies to identify other risk factors for asymptomatic and symptomatic infections are needed.

Validation of Serbian version of the disease-specific myasthenia gravis questionnaire

AIM

The aim of this study was to validate translated and cross-cultural adapted Italian version of myasthenia gravis-specific questionnaire (MGQ) in Serbian MG patients.

MATERIALS AND METHODS

The questionnaire was validated in 140 consecutive MG patients from Belgrade. In each patient association between the total MGQ score and form and severity of the disease was determined. Also, correlation between regional domain scores of MGQ and main clinical findings according to Besinger's clinical score was analyzed.

RESULTS

Patients' participation in the assessment was satisfactory with excellent internal consistency and reproducibility. Total MGQ score, as well as domain scores, correlated with highly significant inverse relationship with the disease severity and clinical status of patients at the moment of completing the questionnaire. Furthermore, the bulbar domain of the questionnaire appeared more specific and sensitive than clinical history and examination.

CONCLUSION

We concluded that the Serbian version of the MGQ may be useful as a measure of clinical outcome in patients with MG.

The structure of sterile cytoplasm types within a maize genebank collection

Maize Research Institute (MRI) gene bank maintains a collection of 6000 maize accessions. Within this collection over 100 sources of cytoplasmic male sterility (CMS) were found in field trials, i.e. more than 2% of the total accession numbers. These sources are distributed among Yugoslav open-pollinated varieties (4.56% of them contain CMS), as well as introduced heterozygous genotypes and inbred lines. In order to identify cytoplasm types the gene-bank sources of CMS were screened using a PCR assay with specific primers for C, T and S cytoplasms. Predominant cytoplasmic male sterility type among the analyzed accessions was CMS-S. Results were inconclusive for three accessions, i.e. different results for the progenies of two ears per accession were obtained. For another two accessions a new PCR product profile was identified, consisting of one band characteristic for CMS-S and one unspecific for any of the three CMS types. The PCR approach enabled a simple, fast and reliable large scale screening of maize cytoplasm among MRI gene bank accessions, significantly reducing time for cytoplasm characterizations compared to classical method of testing with restorers for each known type of CMS.

Ssr analysis for genetic structure and diversity determination of maize local populations from former Yugoslavia territories

A collection of 2178 local populations from ex-Yugoslavia territories is maintained in Maize Research Institute (MRI) gene bank. These populations were characterized mainly by morphological markers. In this work 21 local populations belonging to seven different agro-ecological groups have been subjected to SSR analysis using a DNA-pooling strategy. The objective of this work was to develop genetic fingerprints for characterization, identification and classification of the populations, as well as for estimation of their genetic diversity. Also, a DNA-pooling strategy was employed with the aim to certify if it could be applied for population analysis with SSR markers. Statistical analysis of 25 informative SSR primers revealing 224 alleles (bands) showed that the average within-population mean number of alleles was 2.55, the average values for total and within-population diversity were 0.784 and 0.502, respectively and G(ST) value was 0.360. Genetic distance values calculated using Modified Rogers' Distance were in the range from 0.35 to 0.60. The silver staining method of DNA used for bulked samples showed some weakness that could be overcome with a more sensitive staining method. Nevertheless, the results in this work indicate that the SSR analysis of bulks could be used for characterizing a large number of populations in gene banks.

Undercooked meat consumption remains the major risk factor for Toxoplasma infection in Serbia

Toxoplasma gondii infection prevalence and infection risk factors were analyzed in a series of 765 women of generative age from throughout Serbia tested at the Institute for Medical Research Toxoplasmosis Laboratory between 2001 and 2005. The infection risk factors were additionally analyzed in a group of 53 women with acute infection (cases) compared to a group of seronegative women matched for age and education level (controls). The overall prevalence of infection was 33%. Infection risk factors in the whole series were undercooked meat consumption (RR = 1.77, 95% CI = 1.16-2.7, P = 0.008) and exposure to soil (RR = 1.63, 95% CI = 1.17-2.29, P = 0.004), particularly in less educated women. Moreover, undercooked meat consumption was the single predictor of infection in women with acute infection, with an 11-fold increased risk of infection in women who acknowledged consumption of undercooked meat (RR = 11.21, 95% CI = 3.10-40.53, P = 0.000). These data prompted us to analyze the significance of consumption of particular meat types as sources of infection. Of all the meat types mostly consumed in Serbia, only consumption of beef (RR = 1.006, 95% CI = 1.001-1.011, P = 0.027) was shown to influence Toxoplasma infection rates.

Elevated serum uric acid reduce heart damage in patients undergoing opern-heart surgery

OBJECTIVES

Peroxynitrite is species claimed to propagate ischemia/reperfusion damage. In this report levels of serum uric acid (UA), a peroxynitrite scavenger, are compared with creatine phosphokinase (CPK) in male patients before and after open-heart surgery in order to asses if increased levels of UA may protect heart from biochemical damage induced by peroxynitrite during the coronary by-pass grafting (CABG) intervention.

METHODS

45 male patients (16 carvedilol pretreated (6.25 mg/ daily, during 6 weeks before surgery, mean age 55.3+/-1.7 years, range 50-71) and 29 patients without carvedilol pretreatment (mean age 58.3+/-1.4 years, range 47-73) underwent elective CABG were examined. Study inclusion criteria were CABG performed on two and more coronary-vessels with aortic cross-clamp during 30-40 minutes. For assessment of patients objective health status before operations EuroSCORE were used. Serum uric acid (UA) levels and creatine phosphokinase (CPK) were measured spectrophotometricaly by using a quantitative enzymatic assay.

RESULTS

Carvedilol pretreated patients had higher amount of serum UA (p<0.05) comparing to non-treated patients. During the surgical procedure patients are subjected to temporary ischemia due to transfer from corporeal to extracorporeal circulation. In this period of time the amount of UA decreased in carvedilol pretreated group (406+/-46 (tl) vs. 300+/-22 mmol/L (t2)) to the level of non-treated patients (328+/-14 (t1) vs. 322+18 mmol/L. Carvedilol pretreated patients and non-treated patients had the same level of CPK at the beginning of the surgical procedure (tl) (78+/-6 vs. 83+13 U/L) but lower increase (p<0.05) in CPK activity in carvedilol pretreated patients in respect to non-treated patients (338+46 vs. 644+103 U/L) at the end of procedure (t2). Such results suggest that open heart surgery led to elevated CPK levels, but this effect was less pronounced in patients with higher level of UA.

CONCLUSIONS

Our results suggest possible role of UA in the protection from reperfusion injury. Increase of UA before surgery may be beneficial factor during CABG procedure in patients treated with carvedilol by decreasing level of peroxynitrite as one of molecular causes of reperfusion injury. Our results showed influence of UA on CPK levels at the end of surgical procedure, indicating that increased levels of UA may protect heart from biochemical damage induced by peroxynitrite during the CABG intervention.

Chemical denitrification for nitrogen removal from landfill leachate

A new system that removes nitrogen from landfill leachate and other waste waters with similar properties has been proposed with nitritation (i.e. oxidation of ammonium to nitrite) of half of the influent ammonium followed by chemical denitrification with a reaction between equal amounts of ammonium and nitrite to form nitrogen gas. Chemical denitrification occurs at high concentrations and the reactions were studied in combination with a concentration step. Studied concentration methods were freezing/thawing and evaporation/drying. Chemical denitrification is well-known in inorganic chemistry and has been observed in natural systems. Studies in laboratory were focused on chemical denitrification and showed that nearly complete removal of soluble nitrogen can be obtained in evaporation/drying of water solutions or leachate with equal amounts of ammonium and nitrite. Freezing/drying was less efficient with a removal of about 50-60% at high initial concentrations. Chemical denitrification is much influenced by concentration, pH-value, temperature and some compounds in leachate have an inhibiting effect on the reaction. Factors as safety (ammonium nitrite as a salt is explosive above 60 degrees C) and possible side-reactions as formation of ammonia and nitrogen oxides must be carefully evaluated before use in full-scale. Conductivity is a suitable parameter to follow-up the chemical denitrification process.

Pancreatic polypeptide cells of rat pancreas after chronic ethanol feeding

Male Wistar rats, (2 months old) were randomly divided into two groups according to the diet offered (C-control and E-ethanol treated rats). Final body weight was significantly increased but pancreatic weight as a percentage of body weight was decreased in ethanol treated rats. Volume density, number of pancreatic poly peptide (PP)-cells per islet and per micron 2 of islet were significantly increased. PP-cells were abundant and occupied the whole periphery of islets in the splenic part of the pancreas. Those cells showed strong immunopositivity. At the ultrastructural level PP granules had predominantly less electron density. The mean diameter of PP granules was significantly increased and the number of granules of larger diameter was greater in the E group of rats, than in the controls.

[Health care cooperatives. The role and contributions of this movement in the protection and improvement of the national health status from 1921 to 1949]

After the First World War in the devastated and destroyed country, besides hard economic problems, also many social and sanitary problems required appropriate solutions. Loss of a great number of physicians and other sanitary personnel during the war was badly reflected on health care of the population, especially in rural areas. In these conditions and on suggestions made by a young physician, dr. Gavrilo Kojitsh (Gavrilo Kojić), many health cooperatives were established. Funds were secured by membership fees payed by the members to the so-called patients' funds. These financial resources were intended for covering of expenses in case of illness or death of a cooperative member or a member of his family. Monthly payment depended on the number of family members and degree of health insurance. A cooperative was composed of 300-500 families. The first health cooperatives were established in 1921 and up to 1939 there were 87 cooperatives with 97 physicians and 71 pharmacists. The price of a doctor's consultation was 3-4 times smaller than that in a private doctor's office, and prices of medications and drugs were reduced. In addition to curative treatment, the outpatient service of these cooperatives included maternal and infant care centres with visiting nursing service, sections for fight against infectious disease (vaccination), especially tuberculosis, education, rebuilding of villages, better water-supply, etc. In 1949 these health cooperatives were integrated into the new system of public health services.

[Development of highly specialized clinical drug trial units within health care institutions]

The purpose of the most of clinical trials conducted under the auspices of pharmaceutical industries is to evaluate the safety and efficacy of drugs, and they are conducted at university health care institutions or appropriate clinical centres. Close collaboration among the investigators, potential investigators and other academic citizens is essential for an effective and efficient conduct of these studies. Clinical studies usually test a drug which is to be instituted for the first time; therefore more attention is being dedicated to its administration, with monitoring of a greater number of valid parameters in accordance with the Good Clinical Practices (GCP) and Good Laboratory Practices (GLP) standards. These are very strict standards, which have been internationally adopted and are valid worldwide. They define the documentation required, the setting method, the necessary equipment and the facilities within which the clinical trials are to be conducted, as well as human resources indispensable for carrying out the clinical trials. The objective of this paper was to determine whether our medical instructions fulfil the necessary conditions for establishing the clinical trials units. Creation of a symbiosis of this kind (between the pharmaceutical industry and the appropriate health care institutions), reflected in the clinical trials unit, should enable the drug research and development to remain within our country.

[Levels of fetal fibronectin in the cervix and vagina during pregnancy]

INTRODUCTION

Fibronectin is a glycoprotein produced by different types of cells. It can be divided into two main groups--soluble fibronectin, found in human plasma and other body fluids (amniotic fluid) and tissue fibronectin, found in basal membrane and connective tissue between endothelial cells (2). There are three subtypes--plasmatic, cellular and onco-fetal fibronectin, the most important during pregnancy, with different concentrations during the course of pregnancy. The aim of the study is to establish normal distribution of fetal fibronectin in cervicovaginal fluid during pregnancy in our population and afterwards establish the relation between concentrations in different stages of pregnancy and the pregnancy outcome.

MATERIAL AND METHODS

This prospective, observational study was done at the Department of Obstetrics and Gynaecology, Clinical Centre Novi Sad, during the period June-October 1988. The presented results are preliminary ones. The patients were randomly chosen from the population that came for routine consultations as well as the ones hospitalized at the Department, at the High Risk Pregnancy Unit, for reasons other than threatening miscarriage and preterm delivery. One-hundred and thirty two pregnant women were examined, divided into three groups, according to gestational age. In group I were women between 7-20 weeks, in group II between 21 and 37 weeks and in group III 38 and more weeks. In every case general and obstetric data were collected, and cervico-vaginal fibronectin was taken from the posterior vaginal fornix, using a special kit (Specimen Collection Package, Adeza Biomedical). Fetal fibronectin concentration was tested using enzyme immunoassay (Adeza Biomedical) and positive was considered the concentration of and above 0.05 microgram/ml.

RESULTS

The mean cervico-vaginal fibronectin concentration, uncorrected for the outcome of the pregnancy was as follows--in group I 0.045 (0-0.11) microgram/ml, group II 0.037 (0-1.22) microgram/ml, and in group III 0.226 (0.001-1.05) microgram/ml. The concentration trend was from weakly negative during the period 7-20 weeks, over highly negative (21-37 weeks) to very positive, after 38 weeks. The positive/negative relation in group I was 29.2%/70.8%, group II 11.7%/88.3% and group III 48.4%%/51.6%. After the correction of the results for miscarriages/preterm deliveries/failed induction in postterm pregnancies, the mean concentrations were somewhat different--group I 0.029 microgram/ml, II 0.019 microgram/ml and III 0.282 microgram/ml. The relations of positive and negative results were changed as well and in group I the relation was 27.3%/72.7%, group II 6.8%/93.2% and group III 71.4%/28.6%.

DISCUSSION

After the correction for duration and outcome of the pregnancy, our results differed from the results in the literature. Thus in the 1st trimester fetal fibronectin was positive in cervico-vaginal fluid of 27.3% pregnant women, which is double the number usually found in the literature, between 21 and 37 weeks, when a positive result (> 0.05 microgram/ml) would be expected in only 3% of cases, it was positive in 6.8%, whereas 2.3 of the women delivered at term had a positive concentration. The discrepancy in group II (21-37 weeks) cannot be explained neither with a higher incidence of late miscarriages, nor preterm deliveries, for the incidence of such complications was only 3%, which is far less than usually found in the non-selected population (10%) (9). It is also possible that the discrepancy in our results and the results found in literature is based on a fact that our population was not preselected, which was the case in other studies' populations that did not include women with heavy, non-treated vaginal discharge, nor the ones that had sexual intercourse within 24 hours from the moment of fibronectin sampling. (ABSTRACT TRUNCATED)

Exposure of Mn and FeSODs, but not Cu/ZnSOD, to NO leads to nitrosonium and nitroxyl ions generation which cause enzyme modification and inactivation: an in vitro study

The effect of NO treatment in vitro on structural and functional alterations of Cu/Zn, Mn, and Fe type of SODs was studied. Significant difference in response to NO of Cu/ZnSOD compared to the Mn and Fe types was demonstrated. Cu/ZnSOD was shown to be stable with respect to NO: even on prolonged exposure, NO produced negligible effect on its structure and activity. In contrast, both Mn and Fe types were found to be NO-sensitive: exposure to NO led to their fast and extensive inactivation, which was accompanied by extensive structural alterations, including (in some of the samples tested) the cleavage of enzyme polypeptide chains, presumably at His residues of the enzyme metal binding sites. The generation of nitrosonium (NO+) and nitroxyl (NO-) ions in NO treated Mn and FeSODs, which produce enzyme modifications and inactivation, was demonstrated. The physiological and biomedical significance of described findings is briefly discussed.

Synergistic effect of clindamycin and atovaquone in acute murine toxoplasmosis

The effect of clindamycin (CLI) combined with autovaquone (ATO) was examined in a murine model of acute toxoplasmosis. Swiss Webster mice intraperitoneally infected with 10(2) or 10(4) tachyzoites of the RH strain of Toxoplasma gondii were perorally treated with either drug alone (for ATO, 5, 25, 50, or 100 mg/kg of body weight/day; for CLI, 25, 50, or 400 mg/kg/day) or both combined (for ATO plus CLI, respectively, 5 plus 25, 25 plus 25, 25 plus 50, 50 plus 50, or 100 plus 400 mg/kg/day) starting with day 1 for 14 days. Survival was monitored during 7 weeks. Residual infection was assessed by a bioassay of representative 4-week survivors and by parasite DNA detection by PCR for representative 7-week survivors. An effect of treatment was shown in all treatment groups compared to untreated control mice (P = 0.0000). Among mice infected with 10(2) parasites, ATO and CLI at any dose combination protected significantly more animals than ATO alone (P = 0.0000), but compared to CLI alone, given its good effect, the combined drugs were no more effective (P > 0.05). For mice infected with 10(4) parasites, the drugs combined at the lowest and highest doses (5 plus 25 and 100 plus 400 mg/kg/day) were, similarly, more effective than ATO alone (P = 0.035 and 0.000, respectively) but not than CLI alone (P > 0. 05). However, treatment with ATO plus CLI at 25 plus 25, 25 plus 50, and 50 plus 50 mg/kg/day protected 20, 33, and 78% of mice, respectively, compared to virtually no survivals among those treated with either drug alone (P < 0.0005), thus demonstrating a significant synergistic effect of ATO and CLI against T. gondii. Furthermore, the dose of ATO at a given dose of CLI was shown to be critical to the effect. Moreover, the absence of residual infection in some survivors shows the potential of this drug combination to eliminate the parasite.

Treatment protocol determines the efficacy of clindamycin in acute murine toxoplasmosis

To determine the contribution to the efficacy of clindamycin in acute murine toxoplasmosis of treatment protocol variables, groups of Swiss Webster mice inoculated intraperitoneally with 10(2) RH strain Toxoplasma gondii tachyzoites were treated with peroral clindamycin at 25, 50 and 400 mg/kgBM per day for 1, 2 and 3 weeks. While the lowest drug dose applied for a single week prolonged survival time as compared to untreated animals, not even the highest dose applied for 1 or 2 weeks completely prevented mortality. Conversely, 100% protection was achieved with 3-week treatment courses at both 50 and 400 mg/kg per day. While both survival rates and survival times increased in parallel with the drug dose and treatment duration, the latter was shown to be critical to the outcome, suggesting the use of clindamycin as an antitoxoplasmic agent should be as a prolonged course.

[Injuries specific to ice skating--documentation of the injuries of competitive athletes during a pre-season training camp]

A Prospective Study. Competitive figure skaters absolve a comprehensive training schedule. The musculoskeletal system of pair and single skaters have to tolerate enormous impacts, especially throughout landings after repetitive jumps. Intense training leads therefore to specific sports injuries and chromic overuse injuries of the ice skaters. Twenty-five skaters were studied. We concentrated on the different types and localisations of injuries and on the individual loss of training sessions resulting from these injuries. The results are based on questionnaires and a clinical examination of the athletes. Typical acute and chronic injuries in figure skating mainly manifest at the lower extremity. It is striking that the first symptoms often occur during the preseason and persist the complete season or even for several years. The significance of sport specific and not ice skating related influences with regard to injury susceptibility is explained. Methodical "off-ice-training" seems to be useful to prevent injuries resulting from physical dysbalances. Improvements of the skating boots might protect from typical high impact during the landings after repetitive jumps.

Glutathione peroxidase in amyotrophic lateral sclerosis: the effects of selenium supplementation

The activity of glutathione peroxidase (GSH-Px) as well as the activities of other antioxidative enzymes: CuZn superoxide dismutase (CuZn SOD), catalase (CAT), glutathione reductase (GR) in erythrocytes, as well as the activity of plasma glutathione transferase (GST), and the plasma content of vitamins E and C were evaluated in 35 sporadic amyotrophic lateral sclerosis (sALS) patients. The results revealed significantly decreased activity of both GSH-Px and CuZn SOD in sALS patients compared with the control. These data showed that a disturbed oxidative/antioxidative balance in sALS patients exists not only in motoneurons but also in the blood. The effect of exogenously administered selenium (Se), antioxidants, amino acids, a Ca2+ channel blocker such as nimodipine, and their combination in Alsamin was evaluated by screening parameter levels after 9 weeks of treatment. Only the use of all components together enhanced the activity of GSH-Px and the amount of vitamin E in sALS patients. Judging by the results of clinical trials, this treatment slowed the course of the disease.

[Intestinal parasitic infections in Serbia]

To determine the public health significance of intestinal parasitism in Serbia today, systematic parasitologic examination of 16 regions (Kragujevac, Luchani, Zhagubica, Bor, Sjenica, Novi Pazar, Valjevo, Aleksandrovac, Pirot, Bosilegrad, Ivanjica, Golubac, Uzhice, Kladovo, Negotin, Beograd) in central Serbia were carried out over the period 1984-1993. The study involved a total of 5981 schoolchildren (2887 F, 3094 M), 7-11 years old representing 10% of the total age-matched population (N = 58,228) of the examined regions, residing in 91 settlements. Field parasitological examinations included the examination of perianal swabs for E. vermicularis and Taenia sp., and examination of a single feces sample by direct saline smear and Lugol stained smear for intestinal protozoa, and the Kato and Lörincz methods for intestinal helminths. Nine species of intestinal parasites were detected, of which five protozoan: Entamoeba histolytica (0.02%), Entamoeba hartmanni (0.02%), Entamoeba coli (1.3%), Iodamoeba bütschlii (0.02%), Giardia lamblia (6.8%), and four helminthic: Hymenolepis nana (0.06%), Enterobius vermicularis (14.7%), Ascaris lumbricoides (3.3%), Trichuris trichiura (1.8%). The overall prevalence of intestinal parasite infections amounted to 24.6% (1207/4913), with a highly significant difference (p < 0.001) between particular sites (range 14.4%-43.8%) (Figure 1). Helminthic infections (810) were significantly more frequent (p < 0.001) as compared to both protozoan (296) and combined helminthic-protozoan infections (101). Of these, two species (G. lamblia, E. vermicularis) were found in all examined regions, three (E. coli, A. lumbricoides, T. trichiura) were detected in two or more, while four species (E. histolytica, E. hartmanni, I. bütschlii, H. nana) were each found in a single region (Figure 2). The predominant species (E. coli, G. lamblia, E. vermicularis, A. lumbricoides, T. trichiura) were distributed at considerably different prevalence rates, with a significant difference between the minimal and maximal values (p < 0.01). Of 91 settlements examined, intestinal parasites were found in all but one. However, the prevalence rates in 90 settlements varied significantly (p = 0.0004), from a low of 5.9% to a high of 66.7%. Thus, according to the World Health Organization criteria [19], infections with the four clinically relevant species (G. lamblia, E. vermicularis, A. lumbricoides, T. trichiura) ranged from sporadic to endemic and hyperendemic (Figure 3). The results obtained provide the basic epidemiological data about intestinal parasite infections in Serbia, and indicate their significance in terms of both the number of species and their respective prevalence rates. Given the significant differences obtained in the frequency and distribution of particular parasite infections in different regions, a programme for the control of these infections in Serbia should obviously include a wide variety of measures.

Changes in neuropeptide levels after brain damage in rats

The physiological and pathophysiological roles of neuropeptides are still not clear. The aim of our study was to detect long lasting changes of vasoactive-intestinal peptide (VIP), somatostatin (SOM) and substance P (SP) contents in the rat cerebral cortex and hippocampus after brain lesion. The experiments were performed on groups of adult male Wistar rats. The first group consisted of animals with unilateral ablation of the sensorimotor cortex performed at the age of 60 days. The second group was a control one (rats of the same age but with an intact brain). Both groups of animals were sacrificed at the age of 90-105 days and radioimmunoassay was used to determine amounts of VIP, SOM and SP. The mean values of VIP levels were decreased significantly only in contralateral cortical areas, while there was an increase of SP in lesioned animals. Our results suggest that descrete changes in neuropeptide levels occur during restorative processes after brain lesion.

[Sepsis in surgery patients]

The aim of the study was to determine therapeutic possibilities in surgical patients with sepsis following gunshot wounds of the abdomen and lower extremities. Thirty patients who underwent repeated surgical procedures in general or peridural anesthesia were analyzed. Eleven patients developed ARDS, of which 7 also had acute renal insufficiency and required hemodialysis. Mechanical ventilatory support and PEEP therapy were instituted. In 4 cases, alprostidil at a dosage of 0.1 microgram/kg body weight/min over 2 days was given. Empirical use of antibiotics was at the beginning of the therapy carried out by penicillin, gentamicin and metronidazole and later according to the antibiogram. One patient presented with spinal meningitis after the insertion of peridural catheter.

Effects of age-targeted treatment of intestinal parasite infections in Serbia

A survey of intestinal parasite infections in school-children throughout Serbia revealed an area of endemic infection where 31% of the children examined were found to be infected with Giardia lamblia, Enterobius vermicularis, Ascaris lumbricoides and Trichuris trichiura. All infected children were treated with metronidazole for giardiasis and mebendazole for helminthic infections. A post-chemotherapy survey was performed 3 months later to assess the efficacy of treatment, showing a decrease in the prevalence of all species, thus indicating drug efficacy of 66-100%. A second survey, performed 13 months after chemotherapy to assess the rates of reinfection, showed that only Ascaris lumbricoides prevalence returned to the pre-treatment level. The results of this field study prove chemotherapy to be an important tool in the control of intestinal parasite infections.

Asymmetrical modulation of immune reactivity in left- and right-biased rats after ipsilateral ablation of the prefrontal, parietal and occipital brain neocortex

We report here on the lateralized brain immunomodulation in male Wistar rats, a phenomenon related to the rotational bias of animal and the site of cortical lesion. Rats assigned to left- and right-rotators in a cylindrical Plexiglass rotometer were subjected to the ablation of the ipsilateral prefrontal cortex (PFC), parietal cortex (PC) and occipital cortex (OC) and sensitized with bovine serum albumin (BSA) in complete Freund's adjuvant. Intact and sham-lesioned left-biased animals demonstrated increased Arthus and delayed hypersensitivity skin reactions and antibody production to BSA in comparison with corresponding right-biased animals. PFC ablation decreased humoral and cellular immune responses to BSA in left- but increased in right-biased rats. Lesioning of PC decreased humoral immune reactions in left- but increased in right-rotating animals. OC ablation failed to produce immunological abnormalities. These results suggest that immunopotentiation is associated with the left neocortex, and immunosuppression with the right neocortex. The prefrontal cortex appears to be particularly associated with immune reactions.

A stereological investigation of rat endocrine pancreas after a long-term low-protein diet

Stereological analysis of rat endocrine pancreas was carried out after 4 months of low-protein intake. Thirty make Wistar rats, aged 2 months at the beginning of the experiment, were divided into three groups. The control group (NP) received a standard laboratory diet. The experimental group (LP) received a low-protein diet, and the pair-fed animals also received a standard laboratory diet, as the NP rats did, but restricted to the amounts consumed by the LP group. All groups were offered drinking water ad lib. Weibel's multipurpose lattice was used to determine the volume fraction of cells and numerical density of islets in the endocrine pancreas. The results showed that the long-term low-protein diet decreased the volume fraction of B-cells and increased that of A-cells. Numerical density of islets was significantly increased, whereas the absolute number was decreased. The mean number of B-cells per islet was found to be decreased and that of D-cells increased. The mean radius of the islets was decreased, as was the mean surface area.