Hospital information system--project of implementation of SAP information system at Sveti Duh General Hospital

Nowadays, as medical and hospital institutions have been facing a growing need of a more efficient provision of healthcare services to patients, with simultaneous complete monitoring of the successfulness of business activities, integrated information systems appear as the logical choice for the support to hospital business processes. The integrated business information system implemented at Sveti Duh General Hospital is a comprehensive system that supports all hospital, clinical and administrative processes, while providing the basis for decision making regarding the patients and hospital management. The system also enables transfer of all data with specific medical business segments such as laboratory device management. The project for the implementation of the information system was realized in accordance with the requests from the Ministry of Health, applying the proven methodology for the execution of such complex projects. The project team consisted of a number of consultants from b4b Co. from Zagreb, as well as Hospital employees. The new information system is completely ready for going live; however, the necessary decisions have to be made first. The application of the system gives the medical staff more time for their professional work with patients, and through longterm collection and analysis of data on symptoms, illnesses and medical treatments, the information system becomes an important tool for the improvement of health and quality of healthcare system in general.     

No adverse effect of ABVD chemotherapy in a patient with chronic hepatitis C and Hodgkin’s disease

There is insufficient information on the effects of chemotherapy protocols for Hodgkin's disease (HD) and the course of coexisting hepatitis C virus (HCV) infection. A single literature case reported a patient with HD who developed fulminant hepatitis and hepatic coma after receiving chemotherapy. The case described here is of a female patient previously exposed to prolonged war stress, complicated by intravenous drug abuse and chronic hepatitis C. One year after diagnosis of HCV infection she was diagnosed with HD (nodular sclerosis type II, clinical stage IIIB). The patient received six cycles of ABVD chemotherapy (doxorubicin, bleomycin, vinblastine and dacarbazine) resulting in complete remission of HD. There was no hepatitis flare either during or after chemotherapy. In conclusion, there were no adverse effects of the ABVD regimen on the course of HCV infection in this patient who was successfully treated for HD. Because concurrent HCV infection and HD is extremely rare, we discuss here the possibility of the synergistic contribution of chronic war stress and hepatitis C infection in the pathogenesis of HD.     

Infestation of the human kidney with Dioctophyma renale

Human infestation with Dioctophyma renale is presented. Clinical signs and diagnostic findings are unspecific. They are discussed and a conservative therapeutic approach is suggested.     

Hierarchical and Redundant Lymphocyte Subset Control Precludes Cytomegalovirus Replication during Latent Infection

Reactivation from latent cytomegalovirus (CMV) infection is often associated with conditions of immunosuppression and can result in fatal disease. Whether the maintenance of systemic CMV latency is mainly governed by factors of the infected cell or by immune control functions is unknown. Likewise, the putative immune control mechanisms which could prevent the induction and spread of recurrent CMV infection are not clearly identified. We took advantage of latently infected B cell–deficient mice and a sensitive method for virus detection to study CMV reactivation after ablation of lymphocyte subsets. A crucial role of both T lymphocytes and natural killer (NK) cells was demonstrated. Within 5 d after depletion of lymphocytes, productive infection occurred in 50% of mice, and 14 d later 100% of mice exhibited recurrent infection. A hierarchy of immune control functions of CD8⁺, NK, and CD4⁺ cells was established. Reactivation was rare if only one of the lymphocyte subsets was depleted, but was evident after removal of a further subset, indicating a functional redundancy of control mechanisms. The salivary glands were identified as the site of most rapid virus shedding, followed by the detection of recurrent virus in the lungs, and eventually in the spleen. Our findings document a previously unknown propensity of latent CMV genomes to enter productive infection immediately and with a high frequency after immune cell depletion. The data indicate that only the sustained cellular immune control prevents CMV replication and restricts the viral genome to a systemic state of latency.     

Laminar organization of the human fetal cerebrum revealed by histochemical markers and magnetic resonance imaging

The developing human cerebrum displays age-specific changes in its patterns of lamination. Among these, the subplate zone is the most prominent transient compartment because growing major afferent systems temporarily reside in this zone, establish synapses and take part in cellular interactions that are crucial for subsequent cortical development. We explored the potential of magnetic resonance imaging (MRI) for tracing the developmental history of the most prominent cortical layer (the subplate zone) and other laminar compartments of the fetal cerebral wall between 15 and 36 weeks post-ovulation. We found that changes in the MRI lamination pattern of the human fetal cerebral wall are predominantly caused by changes in the subplate zone. Histochemical staining of the extracellular matrix (ECM) enables selective visualization of the subplate zone and correlation with an increase in MRI signal intensity in the subplate zone and ingrowth and accumulation of thalamocortical and corticocortical afferents and their subsequent relocation to the cortical plate. Thus, dynamic changes in the MRI appearance of the subplate zone and histochemical staining of its ECM can be used as indirect parameters for an assessment of normal versus disturbed unfolding of crucial histogenetic events that are involved in prenatal shaping of the human cerebral cortex.     

Sudden senescence syndrome plays a major role in cell culture proliferation

Normal human cells of various types have a finite and predictable proliferative potential in vitro. This limited life span is due to a gradually increasing fraction of senescent cells that appear in the culture in a sudden and stochastic fashion due to a phenomenon referred to as sudden senescence syndrome (SSS). Because nondividing cells increasingly accumulate in the culture, dividing cells have to compensate for nondividers in order to accomplish additional population doubling (PD). Thus, individual dividing cells undergo more divisions, called cell generations (CG), than the number of PDs. Based on integrated experimental data, we calculated maximum CG for normal human diploid fibroblasts (HDF). It appears that for a HDF culture that undergoes 65 PD, the calculated final CG is at least 126. Based on the obtained value for CG we calculated the total size of the culture, both with and without effect of SSS. If no SSS takes place and cells divide by geometrical progression, the culture will grow up to 2(126) or 10(38) cells. By constantly eliminating cells from further divisions, causing cell loss (CL), SSS reduces the total size of the culture at every point during its proliferation. The calculated value for CL is enormous, so that the culture of 10(38) cells is reduced to only 10(19) cells, thus as little as 10(-17)% of its size! Accordingly, by preventing virtually every cell in the culture from reaching its original maximum doubling capacity, SSS appears to be the most important mechanism that influences cell culture proliferation.     

Psychometric Characteristics of the Croatian and the Serbian Versions of the Oral Health Impact Profile for Edentulous Subjects,with a Pilot Study on the Dimensionality

IntroductionThe aim was to adapt the Croatian and the Serbian versions of the Oral Health Impact Profile for the edentulous population (OHIP-EDENT-CRO and OHIP-EDENT-SRB).MethodsThe translation and cross-cultural adaptation were carried out in accordance with accepted international standards. A total of 95 and 177 removable denture wearers were recruited in Croatia and Serbia respectively. The reliability was evaluated by calculating Cronbach’s alpha coefficient and by test-retest (30 participants in each country). The concurrent validity was determined by calculating the Spearman’s rank coefficient between the OHIP-EDENT summary scores and one question related to removable denture satisfaction. Construct validity was determined by exploratory factor analysis (EFA). Responsiveness was determined by comparison of the OHIP-EDENT summary scores before and after dental implant placement to support mandibular overdentures (23 patients in Croatia, 21 in Serbia).ResultsCronbach’s alpha coefficient was 0.92 in Croatia and 0.87 in Serbia. The intraclass correlation coefficient was 0.98 in Croatia and 0.94 in Serbia. In Croatia the Spearman’s correlation coefficient was -0.71 (p<0.001) and in Serbia -0.74 (p<0.001). Both confirmed concurrent validity. Construct validity was tested by EFA, which extracted four factors in each country, accounting for 66.59% of the variance in Croatia and 59.33% in Serbia. Responsiveness was confirmed in both countries by a significant OHIP-EDENT summary score reduction and a high standardised effect size (3.9 in Croatia, 1.53 in Serbia).ConclusionThe results prove that both instruments, the OHIP-EDENT-CRO and the OHIP-EDENT-SRB, have very good psychometric properties for assessing OHRQoL in the edentulous population.     

A single-stage mechanism controls replicative senescence through Sudden Senescence Syndrome

Normal human cells have a finite proliferative potential in vitro. However, some DNA viral proteins, such as SV40 Tg, can alter this and extend the lifespan after which the cells enter crisis, a period when massive cell death occurs. Based on these observations, a two-stage model for cellular senescence has been proposed with a distinct function for each stage. Mortality stage 1 (M1) is hypothesized to cause cell senescence and is activated near the end of the proliferative lifespan, whereas Mortality stage 2 (M2) involves an independent mechanism that causes failure of cell division and crisis. Here, we present experimental evidence demonstrating that inhibition of the onset of Sudden Senescence Syndrome (SSS) by SV40 Tg greatly reduces the appearance of senescent cells in the culture and results in an increase in the population doublings (PD) to that of the number of cell generations (CGs).This is what causes the observed lifespan extension. Our results also provide an explanation for `additional' telomere shortening during this `extended' lifespan. Based on these observations, we suggest that crisis or M2 cannot be considered a `mechanism' controlled by a specific set of genes. Our results do not support the previously proposed two-stage model and indicates SSS as the single, primary mechanism of cell senescence. Several recent findings from other laboratories that support our previously published self-recombination model of the molecular mechanisms that control SSS are discussed. This revised version was published online in July 2006 with corrections to the Cover Date.     

A biomarker that identifies senescent human cells in culture and in aging skin in vivo.

Normal somatic cells invariably enter a state of irreversibly arrested growth and altered function after a finite number of divisions. This process, termed replicative senescence, is thought to be a tumor-suppressive mechanism and an underlying cause of aging. There is ample evidence that escape from senescence, or immortality, is important for malignant transformation. By contrast, the role of replicative senescence in organismic aging is controversial. Studies on cells cultured from donors of different ages, genetic backgrounds, or species suggest that senescence occurs in vivo and that organismic lifespan and cell replicative lifespan are under common genetic control. However, senescent cells cannot be distinguished from quiescent or terminally differentiated cells in tissues. Thus, evidence that senescent cells exist and accumulate with age in vivo is lacking. We show that several human cells express a beta-galactosidase, histochemically detectable at pH 6, upon senescence in culture. This marker was expressed by senescent, but not presenescent, fibroblasts and keratinocytes but was absent from quiescent fibroblasts and terminally differentiated keratinocytes. It was also absent from immortal cells but was induced by genetic manipulations that reversed immortality. In skin samples from human donors of different age, there was an age-dependent increase in this marker in dermal fibroblasts and epidermal keratinocytes. This marker provides in situ evidence that senescent cells may exist and accumulate with age in vivo.     

Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis

Aim

Primary: to evaluate predictivity of liver stiffness (LS), spleen stiffness (SS), and their ratio assessed by real-time 2D shear wave elastography (RT-2D-SWE) for adverse outcomes (hepatic decompensation, hepatocellular carcinoma or death; “event”) in compensated liver cirrhosis (LC) patients. Secondary: to evaluate ability of these measures to discriminate between cirrhotic patients with/without esophageal varices (EV).

Methods

Predictivity of LS, SS, and LS/SS was assessed in a retrospectively analyzed cohort of compensated LC patients (follow-up cohort) and through comparison with incident patients with decompensated cirrhosis (DC) (cross-sectional cohort). Both cohorts were used to evaluate diagnostic properties regarding EV.

Results

In the follow-up cohort (n = 44) 18 patients (40.9%) experienced an “event” over a median period of 28 months. LS≥21.5 kPa at baseline was independently associated with 3.4-fold (95% confidence interval [CI] 1.16-10.4, P = 0.026) higher risk of event. Association between SS and outcomes was weaker (P = 0.056), while there was no association between LS/SS ratio and outcomes. Patients with DC (n = 43) had higher LS (35.3 vs 18.3 kPa, adjusted difference 65%, 95% CI 43%-90%; P < 0.001) than compensated patients at baseline. Adjusted odds of EV increased by 13% (95% CI 7.0%-20.0%; P < 0.001) with 1 kPa increase in LS. At cut-offs of 19.7 and 30.3 kPa, LS and SS had 90% and 86.6% negative predictive value, respectively, to exclude EV in compensated patients.

Conclusion

This is the first evaluation of RT-2D-SWE as a prognostic tool in LC. Although preliminary and gathered in a limited sample, our data emphasize the potential of LS to be a reliable predictor of clinical outcomes and the presence of EV in LC patients.Over the last decade non-invasive methods have increasingly replaced liver biopsy (LB) for the purpose of determination of the stage of liver fibrosis (LF) (1). Among different diagnostic approaches, ultrasound (US) based transient elastography (TE) has been widely accepted by the hepatologists due to its simplicity and reliability, with a huge amount of data to support its use in different etiologies of liver diseases (2). On the other hand, TE has limitations due to the fact that it does not allow two-dimensional (2D) imaging of the investigated structures, cannot be applied in patients with ascites, and investigation of the spleen can be performed only when proper spot has been chosen by conventional ultrasound. These limitations have been overcome by new US devices in which quantitative elastography module has been integrated into conventional abdominal probes (encompassing acoustic radiation force impulse imaging [ARFI] and real-time 2D-shear wave elastography [RT-2D-SWE]), making it possible to perform gray-scale, Doppler, and elastographic investigations at the same time, in the same patient, with the same US probe (3). These elastographic methods have also been tested in different patient populations, mainly with chronic viral hepatitis, and the results were comparable to TE (4,5). Apart from being used to determine the stage of liver fibrosis, TE has been shown to be able to differentiate between the patients with and without clinically significant portal hypertension (especially if combined with other parameters such as platelet counts or spleen size), esophageal varices (EV), and as a reliable prognostic indicator of liver decompensation and death even independent of the history of treatment in patients with viral hepatitis C (6-8). Although most of these outcomes have been related to the liver stiffness (LS) as assessed by TE, spleen stiffness (SS) has recently attracted attention as well. SS correlates even better with portal hypertension and therefore might also predict the risk of hepatic decompensation and death (9,10). Most of these data have been collected by TE, whereas RT-2D-SWE, to the best of our knowledge, has not been evaluated in this respect. The primary aim of this proof-of-concept study was to evaluate whether RT-2D-SWE might be used as a prognostic tool to predict adverse outcomes in patients with compensated cirrhosis by assessing LS, SS, and their ratio. Considering the ability of the method to evaluate LS even in the presence of ascites, we defined two secondary objectives: first, to compare elastographic indicators in compensated liver cirrhosis (LC) patients to a concurrent group of incident patients with decompensated disease, and second, to assess whether elastographic indicators discriminated between the presence and absence of EV.