The clinical and predictive value of C-reactive protein/albumin ratio in critically ill and mechanically ventilated adult patients

Introduction: CPR/albumin ratio represents a new biomarker that integrates two laboratory-tested acute phase reactants: a positive one (C-reactive protein) and a negative one (albumin), and which can be used as an indicator of the severity, progression and outcome of various illnesses, including critical illnesses. In this retrospective study, we investigated the impact of the CRP/albumin ratio on the clinical characteristics and outcome of the treatment of critically ill and mechanically ventilated adult patients. Patients and methods: This retrospective study included 100 critically ill patients (65 % males and 35 % females; median age of 67) treated at the medical intensive care unit (ICU) which required the use of invasive mechanical ventilation. The primary diagnoses upon admission to the intensive care unit were: sepsis and septic shock (39 %), acute heart failure or worsening chronic heart failure (20 %), exacerbation of chronic obstructive pulmonary disease (16 %), pneumonia (11 %), acute kidney injury or the exacerbation of chronic kidney disease (7 %) and other conditions (7 %). Results: Correlation analysis showed a significant moderate positive correlation between CRP/albumin ratio and the duration of mechanical ventilation measured in hours (r = 0.48, p = 0.001) and the time spent in the intensive care unit, measured in days (r = 0.44, p = 0.001). The median of the CRP/albumin ratio was 58.77 and the patients in the above-the-median group had a higher SOFA score. In terms of the outcomes, it has been determined that the surviving patients (56 %) had a significantly lower CRP/albumin ratio compared to those that had not survived (44 %), which correlates with their SOFA scores as well. In the group of survivors, the correlation between the ratio of CRP/albumin and the SOFA score is positive and statistically significant (r = 0.29, p = 0.03), in the group non-survivoris (r= 0.45, p = 0.003.) Conclusion: Based on the results of our study, the CRP/albumin ratio has proved to be a good predictor of clinical characteristics and outcomes of critically ill and mechanically ventilated patients

Application of Polyglycolic-Polylactic Synthetic Co-Polymer in Periodontal Intrabony Defects

U ovome radu prikazana je klinička primjena poliglikolno-polilaktičnoga ko-polimera Fisiografta u dva klinička slučaja. U prvom slučaju dijagnosticiran je parodontni apsces i oštećenje interradikularne alveolne kosti zuba 46. Oštećenje kosti interradikularno bilo je vidljivo pošto je otvoren mukoperiostalni režanj. Korijen je ostrugan i upalno tkivo oprezno uklonjeno, a defekt je ispunjen usatkom Fisiografta (Ghimas S.p.A - Italy) u obliku gela i praha ovlažen krvlju te prekriven koronarno pomaknutim režnjem. Postoperativno je preporučeno ispirati usta 0,2% otopinom klorheksidin diglukonata. Rezultati tretmana praćeni su klinički i radiografski 6 mjeseci nakon zahvata. Sondiranjem parodontnih džepova prije zahvata u prvom slučaju izmjerena je dubina od 8 mm, a gubitak razine parodontnog pričvrstka 10 mm na zubu 46. Klinička procjena 6 mjeseci nakon zahvata pokazala je da je dubina parodontog džepa smanjena od 8 na 4 mm, a dobitak razine pričvrstka bio je od 10 na 5 mm, što iznosi 50 % od početnoga defekta. U drugom slučaju, nakon što je odignut mukoperiostalni režanj zuba 21, prikazan je opsežni intrakoštani defekt koji je zahvaćao više koštanih stijenki. Pošto smo ostrugali i ispolirali korijen, ispunili smo defekt usatkom Fisiografta u obliku gela i praha ovlažena krvlju. Zbog aktivnosti parodontnoga džepa, ordinirali smo pacijentu tablete Amoksicilina od 500 mg kroz 5 dana 3 puta na dan. Postoperativno je preporučeno ispirati usta otopinom 0,2 % klorheksidin diglukonata. Šest mjeseci nakon zahvata klinički je nalaz pokazao smanjenu dubinu parodontnog džepa i dobitak razine pričvrstka od 4 mm, tj. 44,5 % od početnoga kliničkog defekta. Radiografski nalaz pokazao je smanjenu radiolucentnost alveolne kosti zuba 21, što potvrđuje stvaranje nove potporne alveolne kosti. Može se reći da se je primjena Fisiografta pokazala uspješnom u obnavljanju alveolnog intrakoštanog defekta. Na radiografskoj snimci vidljiva je znatno manja radiolucentnost, a dubina je parodontnog džepa šest mjeseci nakon zahvata smanjena oko 50%. Kako se primjena Fisiografta pokazala uspješnom u procesu cijeljenja alveolne kosti oštećene parodontitisom, preporučuje se taj usadak primijeniti na većem broju ispitanika te provesti i kontrolno ispitivanje.The paper presents two cases of clinical application of polyglycolicpolylactic co-polymer Fisiograft. In the first case periodontal abscess and damaged interradicular alveolar bone of tooth 46 was diagnosed. Interradicular damage to the bone was visible after opening the mucoperiosteal flap. Scaling of the root and careful elimination of the inflamed tissue was performed and the defect filled with Fisiograft implant (Ghimas S.p.A - Italy) in the form of gel and powder, moistened with blood and covered with a coronally positioned flap. Postoperatively the patient was advised to rinse her mouth with 0.2% chlorhexidine digluconate solution. The results of the treatment were monitored clinically and radiographically six months after the procedure. Probing the periodontal pockets before the procedure revealed a depth of 8 mm and loss of the level of periodontal attachment of 10 mm on tooth 46. Clinical evaluation six months after the procedure showed a reduction in the depth of the periodontal pocket from 8 to 4 mm and attachment level gain of 5 mm, which amounts to 50% of the original defect. In the second case, after raising the mucoperiosteal flap of tooth 21, an extensive intrabony defect was revealed, which involved several bony walls. After scaling and planing the root we filled the defect with a Fisiograft implant in the form of gel and powder, moistened with blood. Because of the activity of the periodontal pocket we prescribed Amoxicilin tablets 500 mg, 3 times daily for 5 days. Postoperatively, the patient was advised to rinse his mouth with 0.2% chlorhexidine digluconate solution. Six months after the procedure the clinical finding showed reduced depth of the periodontal pocket and gain of attachment level 4 mm, i.e. 44.5% of the original clinical defect. The radiograph showed reduced radiolucency of the alveolar bone of tooth 21, indicating the formation of new supporting alveolar bone. Thus, it can be said that the application of Fisiograft proved to be successful in regeneration of the alveolar intrabony defect. Six months after the procedure the radiograph showed considerably reduced radiolucency and depth of the periodontal pocket was reduced by around 50%. In the presented two cases the application of Fisiograft proved successful in the process of healing alveolar bone, damaged by periodontitis, and it is therefore proposed that this implant is applied in a larger number of subjects and further investigation carried out

Application of Polyglycolic-Polylactic Synthetic Co-Polymer in Periodontal Intrabony Defects

U ovome radu prikazana je klinička primjena poliglikolno-polilaktičnoga ko-polimera Fisiografta u dva klinička slučaja. U prvom slučaju dijagnosticiran je parodontni apsces i oštećenje interradikularne alveolne kosti zuba 46. Oštećenje kosti interradikularno bilo je vidljivo pošto je otvoren mukoperiostalni režanj. Korijen je ostrugan i upalno tkivo oprezno uklonjeno, a defekt je ispunjen usatkom Fisiografta (Ghimas S.p.A - Italy) u obliku gela i praha ovlažen krvlju te prekriven koronarno pomaknutim režnjem. Postoperativno je preporučeno ispirati usta 0,2% otopinom klorheksidin diglukonata. Rezultati tretmana praćeni su klinički i radiografski 6 mjeseci nakon zahvata. Sondiranjem parodontnih džepova prije zahvata u prvom slučaju izmjerena je dubina od 8 mm, a gubitak razine parodontnog pričvrstka 10 mm na zubu 46. Klinička procjena 6 mjeseci nakon zahvata pokazala je da je dubina parodontog džepa smanjena od 8 na 4 mm, a dobitak razine pričvrstka bio je od 10 na 5 mm, što iznosi 50 % od početnoga defekta. U drugom slučaju, nakon što je odignut mukoperiostalni režanj zuba 21, prikazan je opsežni intrakoštani defekt koji je zahvaćao više koštanih stijenki. Pošto smo ostrugali i ispolirali korijen, ispunili smo defekt usatkom Fisiografta u obliku gela i praha ovlažena krvlju. Zbog aktivnosti parodontnoga džepa, ordinirali smo pacijentu tablete Amoksicilina od 500 mg kroz 5 dana 3 puta na dan. Postoperativno je preporučeno ispirati usta otopinom 0,2 % klorheksidin diglukonata. Šest mjeseci nakon zahvata klinički je nalaz pokazao smanjenu dubinu parodontnog džepa i dobitak razine pričvrstka od 4 mm, tj. 44,5 % od početnoga kliničkog defekta. Radiografski nalaz pokazao je smanjenu radiolucentnost alveolne kosti zuba 21, što potvrđuje stvaranje nove potporne alveolne kosti. Može se reći da se je primjena Fisiografta pokazala uspješnom u obnavljanju alveolnog intrakoštanog defekta. Na radiografskoj snimci vidljiva je znatno manja radiolucentnost, a dubina je parodontnog džepa šest mjeseci nakon zahvata smanjena oko 50%. Kako se primjena Fisiografta pokazala uspješnom u procesu cijeljenja alveolne kosti oštećene parodontitisom, preporučuje se taj usadak primijeniti na većem broju ispitanika te provesti i kontrolno ispitivanje.The paper presents two cases of clinical application of polyglycolicpolylactic co-polymer Fisiograft. In the first case periodontal abscess and damaged interradicular alveolar bone of tooth 46 was diagnosed. Interradicular damage to the bone was visible after opening the mucoperiosteal flap. Scaling of the root and careful elimination of the inflamed tissue was performed and the defect filled with Fisiograft implant (Ghimas S.p.A - Italy) in the form of gel and powder, moistened with blood and covered with a coronally positioned flap. Postoperatively the patient was advised to rinse her mouth with 0.2% chlorhexidine digluconate solution. The results of the treatment were monitored clinically and radiographically six months after the procedure. Probing the periodontal pockets before the procedure revealed a depth of 8 mm and loss of the level of periodontal attachment of 10 mm on tooth 46. Clinical evaluation six months after the procedure showed a reduction in the depth of the periodontal pocket from 8 to 4 mm and attachment level gain of 5 mm, which amounts to 50% of the original defect. In the second case, after raising the mucoperiosteal flap of tooth 21, an extensive intrabony defect was revealed, which involved several bony walls. After scaling and planing the root we filled the defect with a Fisiograft implant in the form of gel and powder, moistened with blood. Because of the activity of the periodontal pocket we prescribed Amoxicilin tablets 500 mg, 3 times daily for 5 days. Postoperatively, the patient was advised to rinse his mouth with 0.2% chlorhexidine digluconate solution. Six months after the procedure the clinical finding showed reduced depth of the periodontal pocket and gain of attachment level 4 mm, i.e. 44.5% of the original clinical defect. The radiograph showed reduced radiolucency of the alveolar bone of tooth 21, indicating the formation of new supporting alveolar bone. Thus, it can be said that the application of Fisiograft proved to be successful in regeneration of the alveolar intrabony defect. Six months after the procedure the radiograph showed considerably reduced radiolucency and depth of the periodontal pocket was reduced by around 50%. In the presented two cases the application of Fisiograft proved successful in the process of healing alveolar bone, damaged by periodontitis, and it is therefore proposed that this implant is applied in a larger number of subjects and further investigation carried out

Chronic Recurrent Multifocal Osteomyelitis (CRMO) and Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) Syndrome – Two Presentations of the Same Disease?

The two most common entities among generally rare but under-diagnosed autoinflammatory bone disorders are chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Due to their similarities, many authors consider CRMO to be a subtype of SAPHO syndrome. The aim of this study was to compare clinical, laboratory, and imaging features and outcomes of patients with CRMO and SAPHO. The analysis of the data from 6 children with CRMO (four girls and two boys, age 3.5-14 years) and of 6 children (6 boys, age 13.5-17.5 years) with SAPHO syndrome was performed. The initiating symptoms in all patients with CRMO were bone pain with multifocal bone lesions. There were no skin manifestations. Five out of six patients achieved control with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, while one patient required disease-modifying antirheumatic drugs (DMARDs). The initiating symptom in five patients with SAPHO syndrome were severe acne, while in one patient acne occurred two years after the disease onset. Two patients typically developed inflamed sternoclavicular joints and sternum, while the others showed changes affecting other skeletal regions. Three patients achieved control with NSAIDs and corticosteroids, the others required DMARDs and TNFα inhibitors. In comparison with patients with CRMO, patients with SAPHO suffered more frequent and longer lasting exacerbations. In conclusion, CRMO and SAPHO syndrome have an array of common characteristics, but also a number of differences. Nevertheless, further investigation into the etiopathogenesis is required to establish a definite relationship between CRMO and SAPHO. </p

Chronic Recurrent Multifocal Osteomyelitis (CRMO) and Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) Syndrome – Two Presentations of the Same Disease?

The two most common entities among generally rare but under-diagnosed autoinflammatory bone disorders are chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Due to their similarities, many authors consider CRMO to be a subtype of SAPHO syndrome. The aim of this study was to compare clinical, laboratory, and imaging features and outcomes of patients with CRMO and SAPHO. The analysis of the data from 6 children with CRMO (four girls and two boys, age 3.5-14 years) and of 6 children (6 boys, age 13.5-17.5 years) with SAPHO syndrome was performed. The initiating symptoms in all patients with CRMO were bone pain with multifocal bone lesions. There were no skin manifestations. Five out of six patients achieved control with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, while one patient required disease-modifying antirheumatic drugs (DMARDs). The initiating symptom in five patients with SAPHO syndrome were severe acne, while in one patient acne occurred two years after the disease onset. Two patients typically developed inflamed sternoclavicular joints and sternum, while the others showed changes affecting other skeletal regions. Three patients achieved control with NSAIDs and corticosteroids, the others required DMARDs and TNFα inhibitors. In comparison with patients with CRMO, patients with SAPHO suffered more frequent and longer lasting exacerbations. In conclusion, CRMO and SAPHO syndrome have an array of common characteristics, but also a number of differences. Nevertheless, further investigation into the etiopathogenesis is required to establish a definite relationship between CRMO and SAPHO. </p

Evaluation of the Successfulness of Applying Polyglycol Copolymer Bone Replacements in the Treatment of Bone Defects of Odontogenetic Aetiology

Problem cijeljenja koštanih defekata odontogene etiologije najčešći je uzrok neuspjeha kirurškoga liječenja ostitičkog procesa. Ovim radom željeli smo vrjednovati uspješnost cijeljenja koštanih defekata nakon ugradnje novog aloplastičnog kopolimernog - poliglikolnog koštanog implantata (Fisiograft). Obrađeno je 45 ispitanika s ostitičkim procesom na zubima intrakanine regije. Rezultati su vrjednovani na osnovi denzitometrijskog mjerenja u razdoblju od dvanaest mjeseci od ugradnje. Dobiveni rezultati pokazuju da se poliglikolni kopolimerni koštani implantati mogu uspješno rabiti u liječenju koštanih defekata odontogene etiologije. Osnovna im je prednost sporija razgradnja, čime se osigurava povoljniji prostor za apoziciju nove kosti u lumen koštanog defekta, jednostavnost primjene u kliničkome radu i mogućnost međusobnog kombiniranja svih triju ponuđenih oblika.The problem of healing bone defects of odontogenetic aetiology is the most frequent cause of failure in surgical treatment of an ostitic process. The aim of this study was to valorise the successfulness of healing of bone defects after implantation of a new alloplastic copolymer - polyglycol bone implant (Fisiograft). A group of 45 subjects was examined with an ostitic process on teeth of the intracanine region. The results were valorised on the basis of densitometric measurement over a period of 12 months after implantation. The results obtained indicate that polyglycol copolymer bone implants can be successfully used in the treatment of bone defects of odontogenetic aetiology. Their fundamental advantage is slower biodegradation, which ensures a more suitable area for the apposition of new bone in the lumen of the bone defect, simple application in clinical work and the possibility of a mutual combination of all three available forms

The effect of estrogen receptor genotypes on the number of stillborn and mummified piglets in Topigs 20 sows.

Steroidni hormoni imaju ključnu ulogu u postnatalnom razvitku i fiziologiji rasplođivanja ženskih jedinki. Djelovanje ovih hormona očituje se kroz podražaj njihovog receptora. Odsječak gena za estrogeni receptor među prvim je i najistraživanijim kandidatnim genima za reprodukcijsku učinkovitost svinja, naročito za pokazatelje veličine legla. Cilj ovoga istraživanja bio je utvrditi polimorfizam gena estrogenog receptora uporabom restrikcijske endonukleaze i njegovu povezanost s brojem mrtvooprasenih (BMO) i mumificiranih (BMUM) odojaka u prvo-, drugo-, treće- i višepraskinja te skupnom analizom prasenja. Istraživanjem je bila obuhvaćena 101 krmača hibrida Topigs 20 od prvog to sedmog prasenja. Polimorfizam gena estrogenog receptora utvrđen je cijepanjem umnoženih odsječaka gena restrikcijskim enzimom PvuII nakon postupka lančane reakcije polimerazom. Utvrđena je prisutnost dvaju alela, A i B, te triju genotipova. Učestalost genotipova i alela provjerena je χ2-testom. Usporedbom je utvrđeno značajno odstupanje od Hardy-Weinbergova zakona utvrđenih i očekivanih frekvencija genotipova. Prikupljeni podatci analizirani su pomoću općeg linearnog modela izračuna (GLM). Statističkom obradom podataka utvrđena je značajna razlika (P<0,05) između genotipa AB i BB te između genotipa AA i BB (P<0,1) u treće- i višepraskinja s obzirom na BMUM. Krmače s prisutnim alelom A, genotipa AA imale su manji BMO, što ukazuje na poželjan učinak ovoga alela. Dobiveni rezultati omogućit će bolje razumijevanje učinka gena, odnosno genotipa estrogenog receptora na broj BMO i BMUM te njegovu moguću ulogu u genetskoj procjeni za obilježja veličine legla u svinja.Steroid hormones such as estrogen play a central role in the postnatal female physiology and their effects are exerted through its receptors. The estrogen receptor gene is one of the first and most extensively investigated candidate genes for reproductive traits in pigs, especially for litter size. The aim of the study was to investigate the estrogen receptor gene polymorphism using endonuclease PvuII, and its association with the number of stillborn (NSB) and the number of mummified (NMUM) piglets in the first, second, third and subsequent parities and in overall parities. Topigs 20 sows (n = 101) from 1st to 7th parities were analyzed. Estrogen receptor genotypes were detected by the polymerase chain reaction-restriction fragment length polymorphism method. Two alleles (A and B) were identified with three genotypes. Alleles (A and B) and genotype frequencies were determined. Comparison of the observed and expected genotype frequencies was performed using the χ2-test and considerable deviation from the Hardy-Weinberg principle was found. All data were analyzed using the General Linear Model. Statistical analysis showed a significant difference (P<0.05) in NMUM between the AB and BB genotypes in the third and subsequent parities. The statistical significance of differences between AA and BB genotypes tended to be lower (P<0.1) in the third and subsequent parities in NMUM. The sows with A allele had less NSB, indicating a beneficial effect of this allele, unlike the B allele in NMUM. The results obtained will contribute to the understanding of the effect of ESR genotype on NSB and NMUM, and substantiate genetic evaluation of litter size traits in pigs

Bone mineral density in children with juvenile idiopathic arthritis after one year of treatment with etanercept

Introduction/Objective. Juvenile idiopathic arthritis (JIA) is the most frequent chronic inflammatory, rheumatic disease of childhood, associated with disturbance of bone mineral metabolism, which develops gradually and progressively, and if untreated eventually leads to osteoporosis in adulthood. The aim of our study was to evaluate bone mineral density (BMD) in patients with JIA treated with etanercept over a period of one year. Methods. The prospective cohort study included 94 JIA patients (66 female, 28 male), their median age being 14.77 years. BMD was measured by dual-energy X-ray absorptiometry on the lumbar spine. Disease activity was assessed using the American College of Rheumatology Pedi 50 criteria. Results. After one year of treatment with etanercept, we found a statistically significant increment in all osteodensitometry variables (p < 0.001). Annual enhancement for the whole group was as follows: bone mineral content 15.8%, BMD 7.2%, BMDvol 4.2%. Z-score improved from -0.86 to -0.58 SD at the last visit, but decreased in rheumatoid factor-positive polyarthritis patients. Patients with systemic JIA had the lowest Z-score. Z-score correlated with functional disability level. BMD was lower in the group treated with glucocorticoids. Conclusion. Our results showed significant improvement of bone mineral density in children with JIA after one year of treatment with etanercept. Rheumatoid factor-positive and systemic JIA subtypes and treatment with glucocorticoids are the risk factors for impairing bone mineral metabolism