Radioactivity of Soil in Croatia I: Naturally Occurring Decay Chains

The assessment of environmental radioactivity much relies on radionuclide content in soil. This stems from the significant contribution of soil to both external and internal exposure to ionising radiation via direct emission of gamma radiation and soil-to-plant radionuclide transfer, respectively. This motivated us to carry out a systematic research on the radioactivity of soil in Croatia to obtain relevant data that can be used as a basis for understanding the related effects of geomorphological, biogeographical, and climatological properties of the environment. We collected samples of the surface layer of uncultivated soil (0–10 cm) at 138 sites from all over the country and measured them for radionuclide activity concentrations by means of high-resolution gamma-ray spectrometry. This resulted in radioactivity maps containing data on activity concentrations of representative radionuclides in the environment. In this paper, which is the first in our two-part presentation, we focus on the naturally occurring ²³²Th and ²³⁸U decay chains and their correlations with the diversity of Croatian regions. For both of the chains, activity concentrations were the highest in the Dinaric region, the lowest in the Pannonian region, and intermediate in the Adriatic region. Relatively high concentrations of ²²⁶Ra in the soil of the Dinaric region implied a possibility of an enhanced emanation of its progeny ²²²Rn into the air. Activity concentrations of ²¹⁰Pb were additionally elevated in areas with dense vegetation, most probably due to an atmospheric deposition of airborne ²¹⁰Pb onto the surface of plants and their eventual decomposition on the ground.Key words: ²¹⁰Pb, ²²²Rn, ²²⁶Ra, ²³²Th, ²³⁸U, gamma radiation, high-resolution gamma-ray spectrometry, representative radionuclides     

Real-world Management of Women with Postmenopausal Osteoporosis Treated with Denosumab: A Prospective Observational Study in the Czech Republic and Slovakia

Introduction

Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fracture. In randomized controlled trials, denosumab has been shown to significantly reduce the fracture risk in women with osteoporosis. However, little is known about the real-world management of women who are prescribed denosumab.

Methods

This multicenter, prospective, observational real-world study in the Czech Republic and Slovakia evaluated the baseline characteristics and clinical management of women with postmenopausal osteoporosis prescribed denosumab for 24 months.

Results

A total of 600 women were included (300 in each country). In the Czech Republic and Slovakia, respectively, mean age at enrollment was 69.0 and 64.3 years, 67.7% and 30.0% of patients had a previous osteoporotic fracture, and 85.0% and 48.7% had previously received osteoporosis medication. In both countries, ‘low BMD T score’ and ‘a history of osteoporotic fracture’ were the main reasons for prescribing denosumab. Most patients received all four post-baseline denosumab injections (Czech Republic, 82.0%; Slovakia, 81.0%), and more than 98% of patients in both countries received all injections at the prescribing center. At 24 months, most patients experienced an increase in BMD T score for the lumbar spine, total hip, or femoral neck (Czech Republic, 69.7–91.7%; Slovakia, 67.1–92.9%). Adverse drug reactions were consistent with the known safety profile of denosumab.

Conclusion

Baseline characteristics of patients receiving denosumab in the Czech Republic and Slovakia reflect the reimbursement criteria for this agent in each country. The findings of our study in patients who are at high risk for fracture are consistent with the growing body of evidence demonstrating the effectiveness of denosumab in real-world clinical practice.

Trial Registration

ClinicalTrials.gov identifier, NCT01652690.

Funding

Amgen Inc.

     

Vitamin D status, dependence on age, and seasonal variations in the concentration of vitamin D in Croatian postmenopausal women initially screened for osteoporosis

Vitamin D deficiency is associated with secondary hyperparathyroidism, increased bone turnover, and bone loss, leading to increased risk for osteoporotic fractures. The objective of this study was to investigate the prevalence of inadequate (insufficient or deficient) serum vitamin D levels in Croatian postmenopausal women initially screened for osteoporosis. Assessment of 25-hydroxyvitamin D (25(OH)D) was performed in 120 Croatian postmenopausal women aged ≥50 years. Three cut-off levels of vitamin D inadequacy were investigated: <75, <50, and <30 nmol/L. Among the included patients, only 14.2% of women complied with diagnostic criteria for osteoporosis. A total of nine (7.5%) had vitamin D levels greater than 75 nmol/L, suggesting that 92.5% of postmenopausal women had inadequate vitamin D status. The prevalence of two different cut-off point groups was 63.3% (<50 nmol/L) and 14.2% (<30 nmol/L). Mean (±SD) serum level of 25(OH)D was 46.94 (16.77) nmol/L. Vitamin D was exhibiting declining values with increasing age (r = −0.28; P = 0.002). The prevalence of vitamin D levels below 30 nmol/L was high in patient aged ≥65 years (23.8%). The highest mean level of vitamin D was detected in summer, with significant differences from spring and winter (P = 0.015 and P = 0.022, respectively). The results of this study indicate a high prevalence of vitamin D inadequacy in Croatian postmenopausal women initially screened for osteoporosis. High prevalence coupled with the rising recognition of potential clinical significance of the vitamin D inadequacy makes this highly interesting intervention target, suggesting that the attempts to increase the awareness on this issue are needed.     

Therapeutic adherence to bisphosphonates.

Therapeutic adherence of patients is a key factor of treatment success in clinical praxis, although it is often neglected. Several studies have shown that insufficient persistence and compliance cause differences in the efficiency of treatments in clinical studies and clinical praxis. A recent meta-analysis even showed a clear inverse relationship between therapeutic adherence and mortality. Factors influencing the adherence to treatment include explanations by the physician, characteristics of the disease, patient's attitudes, but also the therapeutic regime. Osteoporosis as a chronic disorder with relatively long asymptomatic initial course represents a major problem. In addition, the currently available therapeutic regimes are discomfortable and, thus, contribute to the low therapeutic adherence of the patient. One of the factors causing discomfort in bisphosphonates therapy is the frequency of application--once daily or once weekly. Several questionnaire-based studies have shown that patients clearly prefer the new alternative once monthly regime available for ibandronate. Although the efficiency of the drug is proven in large clinical trials, the effects of the once monthly regime itself on hard clinical end-points like mortality can only be analyzed in long-term follow-up studies.     

Impact of a clinical pathway on treatment outcome in patients with acute pancreatitis

AIM:To determine the impact of a clinical pathway(CP) on acute pancreatitis(AP) treatment outcome.METHODS:A retrospective analysis of medical records was performed. We compared the results of AP treatment outcome over two time periods in our centre,before(2006-2007) and after(2010-2012) the implementation of a CP. The CP comprised the following indicators of quality:performance of all laboratory tests on admission(including lipids and carbohydrate deficient transferrin),determination of AP aetiology,abdomen ultrasound(US) within the first 24 h after admission,contrast-enhanced computed tomography of the abdomen in all cases of suspected pancreatic necrosis,appropriately selected and sufficiently used antibiotic therapy(if necessary),pain control,adequate hydration,control of haemodynamic parameters and transfer to the Intensive Care Unit(ICU)(if necessary),endoscopic retrograde cholangiopancreatography(ERCP) in biliary AP,surgical treatment(if necessary),and advice on outpatient follow-up after discharge. A comparison of the length of stay with that in other Slovenian hospitals was also performed.RESULTS:There were 139 patients treated in the three-year period after the introduction of a CP,of which 81(58.3%) were male and 58(41.7%) female. The patients' mean age was 59.6 ± 17.3 years. The most common aetiologies were alcoholism and gallstones(38.8% each),followed by unexplained(11.5%),drug-induced,hypertriglyceridemia,post ERCP(2.9% each) and tumours(2.2%). Antibiotic therapy was prescribed in 72(51.8%) patients. Abdominal US was performed in all patients within the first 24 h after admission. Thirty-two(23.0%) patients were treated in the ICU. Four patients died(2.9%). In comparison to 2006-2007,we found an increased number of alcoholic and biliary AP and an associateddecrease in the number of unexplained aetiology cases. The use of antibiotics also significantly decreased after the implementation of a CP(from 70.3% to 51.8%; P = 0.003). There was no statistically significant difference in mortality(1.8% vs 2.9%). The length of stay was significantly shorter when compared to the Slovenian average(P = 0.018).CONCLUSION:The introduction of a CP has improved the treatment of patients with AP,as assessed by all of the observed parameters.     

LC–NMR and LC–MS identification of an impurity in a novel antifungal drug icofungipen

Successful use of LC–NMR and LC–MS for rapid identification of an impurity in a novel antifungal drug icofungipen has been demonstrated. Complementary information obtained from the two methods made it possible to determine the structure of A1 prior to its isolation and purification. Stop-flow LC–NMR (¹H and DQFCOSY), LC–MS and LC–MS/MS spectra have shown that A1 is structurally related to icofungipen. It was later isolated and prepared synthetically and its structure was corroborated by high-resolution NMR spectroscopy.     

Comparison between cytochemical changes. Concentration of PAS-positive substances in peripheral blood lymphocytes and changes of blood glucose values during the oral glucose tolerance test

Summary The purpose of the study was to analyse the correlation between the blood glucose values and the quantity of PAS-positive substances in lymphocytes observed in different groups of subjects during oral glucose loading. In 300 subjects — 100 persons with a normal OGTT, 100 pregnant women (with normal, borderline and diabetic OGTT), 50 diabetic patients, 20 borderline cases of diabetes, and 30 persons with a ‘lag form’ OGTT — the PAS-index was measured at each point of the OGTT. The values of the PAS-index curve followed the values of the blood glucose level, and the results obtained in different groups of persons were compared. It has been shown that an increased value of the PAS-index is an early sign of disturbed carbohydrate metabolism and that differences between borderline and manifest diabetics, as well as between these groups and normal control persons, are significant. Based on the paper presented on the 10th Annual Meeting of the European Association for the Study of Diabetes, Jerusalem, September 11–13, 1974.     

Omega and inverted omega incision: a concept of uniform incision in breast surgery

In the history of breast surgery, we have seen a lot of changes in orientation, position, and localization of breast incisions. Most of the biopsy incisions have been made with no consideration of future mastectomy or reconstruction because a wide ellipse of skin removed during the mastectomy included the biopsy site. The primary surgical treatment was in the competence of the oncologic or general surgeon. Reconstruction was not an integral part of breast carcinoma therapy and was considered as a secondary, unimportant treatment to be preformed by a plastic surgeon at a later date if desired by the patient. Wide acceptance of conservative breast operations, skin-sparing mastectomy, and reconstruction as an integral part of breast cancer therapy necessitates new consideration about the initial incisions used for breast biopsy. We consider the omega incision not only as a type of incision but also as a concept that can be used for all breast surgery, including biopsy, lumpectomy, skin-sparing mastectomy, and reconstruction.