Epidemiology of multiple sclerosis in western Herzegovina

OBJECTIVES: To determine epidemiological rates of multiple sclerosis (MS) in western Herzegovina. PATIENTS AND METHODS: We analysed data from 81 MS patients (49 females, 32 males) on the prevalence day, 31 December 2003. Patient information was obtained from a search of all available medical records from the period 1994-2003 in the investigated area. RESULTS: Crude prevalence of MS was 27/100,000 (95% confidence interval (CI) 20-34). Prevalence was highest in the mountainous municipality of Posusje (56/100,000) and lowest in the coastal municipality of Neum (0 incidence). The annual incidence of MS was 1.6/100,000 (95% CI 0-3.3). The female/male ratio of MS was 1.5. The mean age of the patients on prevalence day was 40.0+/-11.6 years, and the mean age at disease onset was 31.0+/-7.1 years. Eight (10%) of the patients had a first-degree relative with MS. The primary progressive (PP) disease course was observed only in females. Visual symptoms were the initial symptom of MS in 6 (7%) of the patients. CONCLUSIONS: Western Herzegovina is an area of moderate risk for MS, and the distribution of MS in western Herzegovina is heterogeneous. PP-MS occurred only in females, and involvement of the visual pathways as the initial symptom of MS was low.     

High absolute basophil count is a powerful independent predictor of inferior overall survival in patients with primary myelofibrosis

Objectives: To investigate the clinical and prognostic significance of absolute basophil count (ABC) in patients with primary myelofibrosis (PMF).

Methods: We retrospectively investigated 58 patients with PMF treated in our institution in the period from 2006 to 2017. ABC was obtained in addition to other hematological and clinical parameters. Patients were separated into high and low ABC groups using the Receiver operating characteristic curve analysis.

Results: ABC was higher in PMF patients than in healthy controls (P?P?P?=?0.035), higher lactate dehydrogenase (P?P?P?=?0.030) and massive splenomegaly (P?=?0.014). ABC was also positively correlated with absolute monocyte count (AMC) (P?P?P?=?0.009) in a multivariate Cox regression model adjusted for age, gender, Dynamic International Prognostic Scoring System (HR 2.6, P?=?0.001) and AMC (HR 8.45, P?=?0.002).

Discussion: High ABC reflects higher disease activity and stronger proliferative potential of disease. ABC and AMC independently predict survival and therefore seem to reflect different underlying pathophysiologic processes. Hence, both have a potential for improvement of current prognostic scores.

Conclusion: Basophils represent a part of malignant clone in PMF and are associated with unfavorable disease features and poor prognosis which is independent of currently established prognostic scoring system and monocytosis.     

Visualization of marginal integrity of resin-enamel interface by holographic interferometry

This study determined whether it was possible to detect deformations and fractures in dental hard tissues or in composite material from internal stresses using double-exposure holographic interferometry. On the proximal side of eight intact human permanent premolars, a direct Class II cavity was prepared and restored with a self-etching adhesive (Clearfil SE Bond) and Tetric Ceram, a resin composite. In five of the specimens, Tetric Flow was used as an elastic layer. The samples were illuminated using a helium-neon laser beam, and the holograms of samples were recorded using Agfa 10E75 photographic plates. Hologram reconstructions were captured with an 8-bit monochrome CCD camera and qualitatively analyzed. Deformations and fractures appeared as fringe patterns on all interferograms, where the distribution of fringes provided location information, while the density of fringes gave the amplitude information. Greater fringe densities were observed in samples treated without a flowable composite.     

Venetoclax combinations delay the time to deterioration of HRQoL in unfit patients with acute myeloid leukemia

Phase 3 trials Viale-A and Viale-C evaluated health-related quality of life (HRQoL) in patients with AML unfit for intensive chemotherapy who received venetoclax (VEN) + (AZA) (Viale-A) or low-dose cytarabine (LDAC) (Viale-C) or placebo (PBO) + AZA or LDAC. Patient-reported outcomes included: EORTC QLQ-C30 global health status (GHS/QoL) and physical functioning (PF), PROMIS Cancer Fatigue Short Form 7a (Fatigue), and EQ-5D-5L health status visual analog scale (HS-VAS). Time to deterioration (TTD), defined as worsening from baseline in meaningful change thresholds (MCT) of ≥10, 5, or 7 points for GHS/QoL or PF, fatigue, and HS-VAS, respectively, was assessed; differences between groups were analyzed using Kaplan-Meier and unadjusted log-rank analyses. VEN + AZA vs PBO + AZA patients had longer TTD in GHS/QoL (P = 0.066) and fatigue (P = 0.189), and significantly longer TTD in PF (P = 0.028) and HS-VAS (P < 0.001). VEN + LDAC vs PBO + LDAC patients had significantly longer TTD in GHS/QoL (P = 0.011), PF (P = 0.020), and fatigue (P = 0.004), and a trend in HS-VAS (P = 0.057). Approximately 43%, 35%, 32%, and 18% of patients treated with VEN + AZA, AZA + PBO, VEN + LDAC, or LDAC + PBO, respectively, saw improvements >MCT in GHS/QoL. Overall, VEN may positively impact HRQoL in patients with AML ineligible for intensive chemotherapy, leading to longer preservation of functioning and overall health status.Subject terms: Quality of life, Cancer     

Nuclear Medicine Staff Exposure To Ionising Radiation in 18F-FDG PET/CT Practice: a Preliminary Retrospective Study

This retrospective study provides an insight into the levels of radiation exposure of six nuclear medicine (NM) staff (four technologists and two nurses) performing routine diagnostic ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography-computed tomography (PET/CT) at the University Clinical Centre of the Republic of Srpska, Department of Nuclear Medicine and Thyroid Disorders, Banja Luka, Bosnia and Herzegovina. Data analysis included monthly staff exposure measured with personal thermoluminescent dosimeters (TLD) between June and December 2018, quantified in terms of normalised dose for the whole body [Hp(10)] and dominant hand [Hp(0.07)] and their comparison between each staff member and between the two groups (technologists and nurses). The study goal was to establish how our Department compared with reports from other PET/CT centres worldwide in terms of annual number of procedures and exposure limits and whether there could be room for further improvements in radiation protection. The number of procedures rose considerably from 208 in 2016 to 876 in 2019 and was 423 in the observed seven-month period. Mean individual whole-body exposure dose per GBq of injected ¹⁸F-FDG activity, [Hp(10)/A] was 18.55 μSv/GBq for the four technologists and 15.61 μSv/GBq for the two nurses. Mean dominant-hand exposure dose per GBq of injected ¹⁸F-FDG activity [Hp(0.07)/A] was 16.99 μSv/GBq and 25.44 μSv/GBq for the two groups, respectively. The average annual cumulative dose for all staff was (1.06±0.29) mSv for Hp(10) and (1.15±0.32) mSv for Hp(0.07). These results are comparable with those of similar studies. Staff doses were well below the annual limits. Nurses received slightly higher extremity doses than technologists. In view of the increasing trends in the number of PET/CT procedures, dose monitoring should be continued to identify exposure hotspots and maintain doses as low as possible.Key words: ¹⁸F-fluorodeoxyglucose, ALARA principle, automated dispensing systems, occupational dose, positron emission tomography-computed tomography, thermoluminescent dosimeters, TLD     

Effect of Splenectomy and Autologous Spleen Transplantation on the Serum Platelet-Activating Factor Acetylhydrolase (PAF-AH) Activity and Acute Phase Response (APR) in a Porcine Model

The aim of this study was to evaluate the inflammatory response after total splenectomy and spleen autotransplantation in a porcine model by measuring serum platelet-activating factor acetylhydrolase activity, C-reactive protein and albumin concentrations. Nineteen piglets were used in the experiment. After induction of anesthesia, animals were randomly divided into three groups: sham-operation with spleens intact (n = 6), total splenectomy (n = 6), and splenic autotransplantation (n = 7) with small fragments of the spleen autotransplanted into the greater omentum. The blood samples were taken just before surgery and on day 1st, 5th, 12th, 26th and 40th postoperatively. PAF-AH activity, CRP and albumin concentrations were assayed in the sera. After total splenectomy, PAF-AH activity was significantly increased on day 5th, while there was no significant increase after spleen autotransplantation or the sham-operation. CRP was significantly increased after surgery in all experimental groups. Albumin was significantly decreased after surgery from day 5th until day 40th in splenectomized and autotransplanted pigs. Increased PAF-AH activity after splenectomy and spleen autotransplantation might be attributed to inflammatory conditions due to the loss of splenic tissue and trauma. Time-course increase of CRP, in all groups after surgery suggests post-injury inflammatory response due to tissue lesion during operation.     

Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery

Aim

To assess diagnostic value of perioperative procalcitonin (PCT) levels compared to C-reactive protein (CRP) levels in early detection of infectious complications following colorectal surgery.

Methods

This prospective observational study included 79 patients undergoing elective colorectal surgery. White blood cell count, CRP, and PCT were measured preoperatively and on postoperative days (POD) 1, 2, 3, 5, and patients were followed for postoperative complications. Diagnostic accuracy of CRP and PCT values on each day was analyzed by the receiver operating characteristics (ROC) curve, with infectious complications as an outcome measure. ROC curves with the largest area under the curve for each inflammatory marker were compared in order to define the marker with higher diagnostic accuracy.

Results

Twenty nine patients (36.7%) developed infectious complications. CRP and PCT concentrations increased in the early postoperative period, with a significant difference between patients with and without complications at all measured postoperative times. ROC curve analysis showed that CRP concentrations on POD 3 and PCT concentrations on POD 2 had similar predictive values for the development of infectious complications (area under the curve, 0.746 and 0.750, respectively) with the best cut-off values of 99.0 mg/L for CRP and 1.34 µg/L for PCT. Diagnostic accuracy of CRP and PCT was highest on POD 5, however the cut-off values were not considered clinically useful.

Conclusion

Serial postoperative PCT measurements do not offer an advantage over CRP measurements for prediction of infectious complications following colorectal surgery.Colorectal surgery leads to high rates of postoperative complications, varying between 28% and 38% (1-3). Early diagnosis and prompt treatment of complications is crucial for a favorable outcome. However, surgical trauma induces systemic inflammatory response syndrome (SIRS), which can hinder the diagnosis of postoperative infections (4). Therefore, it would be useful to find a biochemical marker that could accurately differentiate between infectious and non-infectious SIRS.C-reactive protein (CRP), the first of the acute phase proteins to be described, was discovered in 1930 and named for its capacity to precipitate a non-protein somatic fraction (Fraction C) of Streptococcus pneumoniae. It is a sensitive systemic marker of inflammation and tissue damage, but is not specific for infection (5,6). Surgical trauma induces a significant increase in CRP levels, which can reduce its predictive value for the diagnosis of infection in the early postoperative period (7-9). Despite this, an interest in CRP as an infection monitoring tool in the perioperative setting has increased since it was reported that in values higher than 140 mg/L on the postopertaive day (POD) 3-4 it well predicted infectious complications after colorectal surgery (10). Since then, several studies have found it to be a useful predictor of septic complications following colorectal and esophagogastric resections (11-15).Procalcitonin (PCT), the prohormone of calcitonin, was first described as a biochemical marker of infection in 1993 (16). Bacterial endotoxins are potent stimuli for PCT synthesis, which exhibits faster kinetics than CRP. PCT is released into the circulation 3-4 hours after an injection of endotoxin, reaching peak levels after 8-24 hours, while CRP peaks at 36-50 hours after stimulus (5,17). This would make PCT more suitable as an infection monitoring tool in the perioperative setting (18,19). A meta analysis of 33 studies, which included adults in intensive care units or after surgery and trauma, showed that PCT was a good diagnostic marker of sepsis, with greater diagnostic accuracy than CRP (20). Recent studies in surgical patients have also shown that after orthopedic, cardiac, and thoracic surgery PCT was better for detecting postoperative infections than CRP (21-23).To the best of our knowledge, no studies have compared the diagnostic accuracy of CRP and PCT for early detection of postoperative complications in patients undergoing colorectal surgery. The aim of this study was to assess the predictive value of serial postoperative determinations of CRP, PCT, and white blood cell (WBC) count for infectious complications after elective colorectal surgery and to compare the diagnostic accuracy of CRP and PCT.