The A-test: Reliability of functional recovery assessment during early rehabilitation of patients in an orthopedic ward

Background/Aim. There are few tests for evaluation of functional abilities of patients surgically treated for hip fractures or osteoarthritis during early rehabilition period. The aim of this study was to investigate reliability (interobserver reproducibility and internal consistency) of the A-test, an original test for functional recovery evaluation during early rehabilitation of patients in an orthopedic ward. Methods. The investigation included 105 patients (55 patients with hip osteoarthritis that underwent arthroplasty and 50 surgically treated patients with hip fracture). It was conducted in an orthopedic ward during early inpatient rehabilitation (from 1st to 5th day). For their functional recovery evaluation during early rehabilitation we used the A-test, a performance-based test with 10 items for assessing basic activities by six level ordinal scale (0-5). For internal consistency of the test the Cronbach coefficient alpha was calculated for the A-test results collected during early rehabilitation for all patients (105 patients x 5 days = 525 measures) and separately for the results of patients with hip osteoarthritis (275 measures) and hip fracture (250 measures). Values of this coefficient > 0.7 imply good internal consistency of the test. Interobserver reproducibility was estimated as follows: two physiotherapists together conducted physical therapy with the patients, and then, separately, rated the performance of each activity from the test (78 measures). The agreement between their estimations was expressed by the linear weighted kappa coefficient (for very good agreement values of kappa coefficient have to be in the range 0.81-1). Results. The Cronbach coefficient alpha was 0.98 (the results of all the patients and the results of the patients with hip osteoarthritis) and 0.97 (the results of the patients with hip fracture). The values of kappa coefficient were in the range 0.81-0.92 for all items. Conclusion. The A-test is a reliable instrument for everyday evaluation of functional recovery during early rehabilitation of patients surgically treated in an orthopedic ward

Etiological Factors for Epithelial Atypia in Chronic Rhinosinusitis with Nasal Polyps

Aim: Chronic rhinosinusitis with nasal polyps (CRSwNP) or nasal polyposis (NP) is characterized by polypoid outgrowths of chronically inflamed respiratory mucosa. Cellular atypia of stromal fibroblasts as a result of increased intercellular fluid pressure is a well-known histological characteristic of CRSwNP. However, the presence of squamous metaplasia and dysplasia on the mucosal surface of nasal polyps (NPs) is not well investigated. The aim of this study was to evaluate the presence of epithelial atypia in ethmoidal NPs and to find possible etiological factors for this histological feature. Methods: This retrospective analysis of prospectively collected data involved 212 patients with NP undergoing endoscopic ethmoidectomy. To evaluate possible etiological factors for epithelial atypia, the patients in whom we histopathologically detected the presence of epithelial atypia were compared with patients with \u27normal\u27 NPs in accordance with the following characteristics as found in the patients\u27 medical data: gender, age, atopic status, sensitivity to non-steroid anti-inflammatory drugs (NSAIDs), cigarette smoking, and occupational exposure to different noxious factors. Results: Epithelial atypia were detected in 44 (20.7%) NP patients, whereas features of \u27true\u27 dysplasia were found in only one patient (0.5%). The presence of atypia was more frequent in males than in females (p=0.008). The association with non-steroid anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) and with long-term occupational exposure to different noxious chemicals, especially in workers exposed to salts of heavy metals, was more frequent in NP patients with epithelial atypia than in patients without atypia (p=0.023; p=0.006), respectively). Conclusion: Our results suggest epithelial atypia in NPs are associated with NSAID sensitivity and occupational exposure to different noxious chemicals. Although extremely rare, epithelial dysplasia may occasionally be noted in NPs, a fact potentially useful for both rhinologists and pathologists

Opetovani lipomatozni tumor hipofarinksa: prikaz slučaja i pregled literature

Liposarcoma is one of the most common soft-tissue sarcomas in adults, but head and neck are rarely involved, especially regions of the larynx and hypopharynx. According to Enzinger and Weiss, liposarcoma can be divided into 5 subtypes: well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated. We present an unusual case of well-differentiated liposarcoma of the hypopharynx in a patient with previous three procedures of endoscopic removal of hypopharyngeal tumor classified as benign lipoma. Well-differentiated liposarcoma is a tumor of low-grade malignancy, which frequently recurs locally, but does not metastasize. Wide tumor resection with free margins is mandatory. Immunohistochemistry is a useful diagnostic tool. We also discuss recently published literature on this unusual presentation of well-differentiated liposarcoma.Liposarkom je jedan od najčešćih mekotkivnih sarkoma u odrasloj dobi. Usprkos tome, zahvaćenost glave i vrata je rijetka, osobito u regijama larinksa i hipofarinksa. Prema Enzingeru i Weissu, liposarkom se može podijeliti u 5 podtipova: dobro diferenciran, miksoidni (miješani), tumor kružnih stanica, pleomorfni i nediferencirani. Mi predstavljamo neobičan slučaj bolesnika s dobro diferenciranim liposarkomom u hipofarinksu, koji je prije bio tri puta endoskopski operiran, a svaki je put odstranjeni tumor bio dijagnosticiran kao benigni lipom. Dobro diferencirani liposarkom je tumor niskog malignog potencijala, koji često nakon toga opetovano raste, ali ne daje metastaze. Široka resekcija tumora sa slobodnim rubovima je metoda prvoga izbora. Imunohistokemijska analiza je od osobitog dijagnostičkog značenja. Također, u radu se raspravlja o podacima iz novije literature glede neobičnih prikaza dobro diferenciranih liposarkoma hipofarinksa

AN EXAMPLE OF CHATBOT IN THE FIELD OF EDUCATION IN THE REPUBLIC OF SERBIA

Students can retrieve information from the website or use the services of an existing information system (provided the information system is on the internet). However, we know from experience that searching a website is time-consuming or even inaccurate, and the functionality of the information system is limited. Chatbot makes it more natural, efficient and faster. Chatbot can understand natural language, i.e. written text and voice messages. It gives precise answers and performs all actions intended by the website and / or the information system. But the website and the information system do not have the richness of language that the chatbot has. You have to log in to the information system and know how to use it, and each new version requires new learning. If you know how Viber or FB Messenger work, you probably know how to use chatbot. The services provided by chatbot are visible on communication platforms used by a large number of users, and thus the quality of these services is better. Due to the use of chats, the human resources of the educational institution are redirected/retrained to more responsible and creative jobs because the workload has been relieved. The paper presents a chatbot called ADA, developed at the Belgrade Business and Arts Academy of Applied Studies (BAPUSS), and shows basic usage statistics. It also points out the importance of chatbots as a communication channel in educational institutions

Koncentracije proupalnih citokina u nosnom sekretu kao indikatori težine nosne polipoze

The aim of this prospective study was to evaluate whether cytokine levels in nasal secretions may be clinical parameters of severity of nasal polyposis. Forty nasal polyp patients (20 asthmatic and 20 nonasthmatic) requiring surgical treatment were included. Nasal secretion samples were collected from nasal cavities of all 40 subjects. The levels of T-helper type 1 (Th1) proinflammatory cytokines IL -2, IL -12, IFN -g, IL -1β, TNF -α and TNF -β, Th2 cytokines IL -4, IL -5 and IL -6, antiinflammatory cytokine IL -10 and chemokine IL -8 were measured using flow cytometric method. Each of the 40 patients was staged clinically according to global nasal symptom score, endoscopic score, and Lund-Mackay computed tomography (CT) score. Eosinophils were counted in hematoxylin-eosin stained sections of all nasal polyp samples. The concentrations of Th2 proinflammatory cytokines IL -5 and IL -6 were significantly higher (p<0.05 and p<0.01, respectively) in patients with nasal polyposis and asthma compared with nasal polyp patients without asthma. Positive correlations were observed between IL -2 concentration in nasal secretions and nasal symptom score, endoscopic score, and Lund-Mackay score only in nasal polyp patients without asthma. We also found positive correlation between Lund-Mackay score and the levels of IL -8, IL -4, and IL -1β in nonasthmatic patients. A positive correlation between IL -5 levels in nasal fluid and endoscopic score was found only in asthmatic patients. Eosinophil counts were higher in asthmatic patients’ polyps compared with nonasthmatic ones, but without statistical significance. Nasal polyposis in asthmatic patients has different immunological patterns compared to those without asthma. The concentrations of cytokines measured in nasal fluid were not sensitive enough to be universal criteria to determine the severity of all forms of nasal polyposis.Cilj ove prospektivne studije bio je ispitati mogu li koncentracije citokina u nosnom sekretu poslužiti kao klinički parametri za procjenu težine nosne polipoze. U studiju je bilo uključeno 40 bolesnika s nosnom polipozom (20 astmatičnih i 20 neastmatičnih) u kojih je bilo potrebno kirurško liječenje. Uzorci nosnoga sekreta bili su sakupljeni iz nosnih šupljina svih 40 bolesnika. Koncentracije T pomoćničkih-1 (Th1) proupalnih citokina IL -2, IL -12, IFN -γ, IL -1β, TNF -α i TNF -β, Th2 citokina IL -4, IL -5 i IL -6, protuupalnog citokina IL -10 i hemokina IL -8 mjerene su primjenom metode protočne citometrije. Svaki od 40 bolesnika klinički je klasificiran prema zbiru nosnih simptoma, endoskopskom zbiru i Lund-Mackayevu zbiru. Eozinofili su se brojili u uzorcima nosnih polipa obojenim tehnikom hematoksilin-eozin. Koncentracije Th2 proupalnih citokina IL -5 i IL -6 bile su statistički značajno više u astmatičnih nego u neastmatičnih bolesnika s nosnom polipozom (P<0,05, P<0,01). Nađena je pozitivna korelacija između koncentracije IL -2 u nosnom sekretu i zbira nosnih simptoma, endoskopskog zbira i Lund-Mackayeva zbira samo u neastmatičnih bolesnika. Također su utvrđene pozitivne korelacije između Lund-Mackayeva zbira i razina IL -8, IL -4 i IL -1β u neastmatičnih bolesnika. Pozitivna koralacija između koncentracije IL -5 u nosnom sekretu i endoskopskog zbira nađena je samo kod astmatičnih bolesnika. Broj eozinofila bio je veći u tkivu nosnih polipa astmatičnih bolesnika nego u neastmatičnih, ali bez statističke značajnosti. Nosna polipoza u astmatičnih bolesnika ima drugačiji imunološki tijek u usporedbi s neastmatičnim bolesnicima. Koncentracije citokina mjerene u nosnom sekretu nisu dovoljno osjetljiv pokazatelj da bi bile univerzalni kriterij za procjenu težine svih oblika nosne polipoze

Eozinofilna upala u alergijskom rinitisu i nosnoj polipozi

On histopathological examination, nasal polyps and nasal mucosa in allergic rhinitis show different forms of pseudostratified respiratory epithelium, whereas the dominant characteristic of lamina propria is an eosinophilic infiltration. The aim of this study was to compare interleukin (IL)-5 and eosinophilic cationic protein (ECP) levels in the nasal fluid of 42 patients: 12 with allergic rhinitis and nasal septal deviation, 17 non-atopic patients with nasal polyposis, and 13 atopic nasal polyp patients were enrolled in this cross-sectional study. Nasal secretion samples were collected a few days before surgery. The levels of IL-5 were measured using fl ow cytometry and the ECP using a commercial ELISA kit. In addition, we counted eosinophils in hematoxylin-and-eosin-stained sections of all nasal polyp and all nasal mucosa samples taken from the inferior nasal turbinates during septoplasty. A significantly higher concentration of IL-5 was found in the nasal fluid of atopic patients with nasal polyposis than in non-atopic nasal polyp patients (p=0.025) and patients with allergic rhinitis (p=0.05). ECP was higher in atopic nasal polyp patients than in patients with allergic rhinitis (p<0.0001) and than in non-atopic nasal polyp patients (p<0.0001). Polyp eosinophils were higher in atopic’ than in non-atopic patients (p<0.0001) and higher than in the mucosa of patients with allergic rhinitis (p<0.0001). These however had signifi cantly more mucosal eosinophils than was found in the polyps of non-atopic patients’ (p=0.025). ECP levels in nasal fl uid and eosinophil counts in tissue specimens correlated well in all three groups of patients. Our study has shown that atopic nasal polyp patients have a higher level of eosinophilic inflammation than non-atopic patients with nasal polyps and patients with allergic rhinitis.Na histopatološkim pregledima nosni polipi, kao i nosna sluznica u alergijskom rinitisu pokazuju različite oblike pseudoslojevitog respiracijskog epitela, dok je osnovna karakteristika lamine proprije infiltracija eozinofilima. Cilj ove studije bio je usporediti koncentracije interleukina 5 (IL-5) i eozinofilnoga kationskog proteina (ECP) u nosnome sekretu pacijenata s alergijskim rinitisom, neatopičnih i atopičnih pacijenata s nosnom polipozom, kao i usporediti broj eozinofi la u tkivu nosnih polipa/nosne sluznice ovih pacijenata. Četrdeset dvoje (n=42) pacijenata, 12-ero s alergijskim rinitisom i devijacijom nosnog septuma, 17-ero neatopičnih pacijenata s nosnom polipozom i 13-ero atopičnih pacijenata s nosnom polipozom bilo je uključeno u ovu presječnu studiju. Uzorci nosnog sekreta bili su skupljeni iz nosnih šupljina svih ispitanika nekoliko dana prije kirurškog liječenja. Koncentracije IL-5 mjerene su metodom protočne citometrije, dok su koncentracije ECP mjerene komercijalnim ELISA-kitom. Eozinofi li su brojeni u svim uzorcima tkiva nosnih polipa, kao i u svim uzorcima tkiva sluznice uzetih s donje nosne školjke tijekom septoplastike. Značajno više koncentracije IL-5 izmjerene su u nosnom sekretu atopičnih pacijenata s nosnom polipozom u usporedbi s neatopičnim pacijentima s nosnom polipozom (p=0,025) i pacijentima s alergijskim rinitisom (p=0,05). Naši su rezultati pokazali više koncentracije ECP u atopičnih pacijenata s nosnom polipozom nego u pacijenata s alergijskim rinitisom (p<0,0001) i u usporedbi s nealergičnim pacijentima s nosnom polipozom (p<0,0001). Veći broj eozinofi la izbrojen je u tkivu polipa atopičnih pacijenata nego u tkivu polipa neatopičnih pacijenata (p<0,0001), kao i u sluznici pacijenata s alergijskim rinitisom (p<0,0001). U nosnoj sluznici pacijenata s alergijskim rinitisom našli smo značajno veći broj eozinofila nego u polipima neatopičnih pacijenata s nosnim polipima (p=0,025). Konačno, našli smo pozitivnu korelaciju između nivoa ECP u nosnom sekretu i broja eozinofila u uzorcima tkiva u sve tri skupine ispitanika. Zaključili smo da atopični pacijenti s nosnom polipozom imaju viši stupanj eozinofilne upale u usporedbi s neatopičnim pacijentima s nosnim polipima i s pacijentima s alergijskim rinitisom

A Case of an Unilateral Tonsillar Hypertrophy Caused by Actinomycosis

The purpose of this report was to present an unusual case of an unilateral tonsillar hypertophy caused by actinomycosis. It is an infrequent bacterial infection nowadays. Only five such cases have been reported up to now. Diagnosis is difficult, because there are not specific diagnostic procedures. Medical treatment consists of surgical excision of tonsils and postoperative antibiotic therapy

Diagnostic accuracy of the A-test and cutoff points for assessing outcomes and planning acute and post-acute rehabilitation of patients surgically treated for hip fractures and osteoarthritis

Background/Aim. The A-test is used in daily clinical practice for monitoring functional recovery of orthopedic patients during early rehabilitation. The aim of this study was to determine the accuracy of A-test and cutoff point at which the test can separate patients with and without functional disability at the end of early rehabilitation. Also, it was important to determine whether A-test has that discriminative ability (and at which cutoff points) in the first days of early rehabilitation in order to have time to plan post acute rehabilitation. Methods. This measurement-focused study was conducted in the Orthopedic Ward during early inpatient rehabilitation (1st−5th day after the operation) of 60 patients with hip osteoarthritis (HO) that underwent arthroplasty and 60 surgically treated patients with hip fracture (HF). For measurements we used the A-test and the University of Iowa Level of Assistance Scale (ILAS) as the gold standard. For statistical analysis we used the receiver operating characteristic (ROC) curve and the area under the curve (AUC) with 95% confidence interval for the results of A-test from the first to the fifth day of rehabilitation, sensitivity, specificity, the rate of false positive and false negative errors, positive and negative predictive value, ratio of positive and negative likelihood ratio, accuracy, point to the ROC curve closest to 0.1 and Youden index for all the cutoff points. Results. The AUC was 0.825 (0.744−0.905) for the first day of rehabilitation, 0.922 (0.872−0.972) for the second day of rehabilitation, 0.980 (0.959−1.000) for the third day of rehabilitation, 0.989 (0.973−1.004) for the fourth day, and 0.999 (0.996−1.001) for the fifth day of rehabilitation. The optimal cutoff for the results of A-test was: 7/8 for the first day, 29/30 for the fourth day, and 34/35 for the fifth day of rehabilitation. On the second and the third day A-test had two cutoff points, the lower point safely separated the patients with functional disability, while the upper point ruled out functional disability. On the 2nd rehabilitation day the cutoff points were 12/13 and 17/18, on the 3rd rehabilitation day cutoff points were 13/14 and 18/19. Conclusion. The A-test has all characteristics of an accurate tool which can be used for separating patients with and without functional disability at all stages of early rehabilitation after surgically treated hip disease or fracture. Based on the results of A-test within the first days of early rehabilitation, it is possible to make a plan for postacute rehabilitation

The effects of short-term preoperative physical therapy and education on early functional recovery of patients younger than 70 undergoing total hip arthroplasty

Background/Aim. Hip arthroplasty is a routine operation which relieves pain in patients with osteoarthritis. The role of physical therapy after hip arthroplasty was recognized, but the importance of preoperative physical therapy and education is still to be judged. The aim of this paper was to investigate the effect of short-term preoperative program of education and physical therapy on patients' early functional recovery immediately after total hip arthroplasty (THA). Methods. This prospective study included 45 patients with hip osteoarthritis scheduled to undergo primary THA and admitted to the Department of Orthopedics of Military Medical Academy. They were randomized into 2 groups: study and control one (with and without preoperative education and physical therapy). Preoperative education was conducted through conversation (1 appointment with physiatrist) and brochure. The study group was instructed to perform exercises and basic activities from the postoperative rehabilitation program (2 practical classes with physiotherapist). Effects were measured with questionnaires (Harris, Oxford and Japanese Orthopaedic Association (JOA) hip scores), range of motion and visual analog scale of pain. Marks showing ability to perform basic activities and endurance were from 0 (did not perform activity) to 5 (independent and secure). Analyses examined differences between the groups over the preoperative and immediate postoperative periods and 15 months after the operation. Results. There were no differences between the groups at discharge according to pain, range of motion, Harris hip score and JOA hip score. Oxford hip score did not differ between the groups 15 months after the operation. The groups started to walk at the same time, but the study group walked up and down stairs (3.7±1.66 vs 5.37±1.46, p ≤ 0.002), used toilet (2.3±0.92 vs 3.2±1.24, p ≤ 0.02) and chair (2.2±1.01 vs 3.25±1.21, p ≤ 0.006) significantly earlier than the control group. On the third day after the operation the study group was significantly more independent than the control one while performing any basic activities (changing position in bed from supine to side lying, from supine to sitting on the edge of the bed, from sitting to standing, from standing to lying in the bad, standing, walking, using toilet and chair). At discharge the patients from the control group still needed the therapist help for walking up and down stairs (3±1.26), while the patients from the study group performed there activities independently (4.85±0.37) (p ≤ 0.000). Endurance while walking was significantly better in the study group than in the control one. The length of hospital stay after the operation was similar for both groups, but the patients from the study group needed significantly less classes with the therapist (5.2±2.35 vs 6.85±1.14, p ≤ 0.02) during hospital stay. Conclusion. The short-term preoperative program of education with the elements of physical therapy accelerated early functional recovery of patients (younger than 70) immediately after THA and we recommend it for routine use

Clinical usefulness of^99mtc-hynic-toc and¹³¹i-mibg scintigraphy in the evaluation of adrenal tumors

© 2019, University of Kragujevac, Faculty of Science. All rights reserved. Disorders and morphological abnormalities affecting the adrenal gland, could lead to profound clinical consequences, owing to its biochemical structure-activity and morphological characteristics. The recent focus on theranostic approach has led to a need for tumors characterization and early diagnosis at the molecular level. Many radiotracers have been developed with specific imaging characteristics for the adrenal tumors, by exploiting different physiological mechanisms of uptake and metabolism. The aim of present study is to provide a prospective confirmation of131I-MIBG and99mTc-HYNIC-TOC scintigraphy, for the evaluation of patients with known or suspected tumors of the adrenal region. The research is designed as a cross-sectional observational study of the clinical correlates and diagnostic accuracy of radionuclide-based imaging methods in relation to in vitro analysis, clinical manifestations and morphological characteristics of these tumors. Furthermore, the present study also evaluates the usefulness and the clinical impact of each radiopharmaceutical for the detection and management of tumors, and functional imaging modality as well. Visual scintigraphic appearance of an increased focal tracer uptake in the suspected tumor site revealed that99mTcHYNIC-TOC is highly sensitive and reliable tumor-seeking radiotracer for adrenal tumors, but does not distinguish between adenoma and pheochromocytoma, and the existence of hormone secreting adrenocortical tumor cells. However,131IMIBG scintigraphy is highly sensitive and specific method only in differentiating catecholamine-secreting adrenal tumors. Clinical significance of this research is in the accurate localization of adrenal tumors, and is of paramount importance for an algorithmic diagnostic approach and management, and provide the rationale to different therapeutic possibilities