Contemporary approach to primary prophylaxis of venous thromboembolism regarding the impact of risk factors on anticoagulation therapy duration

Odgovarajuća tromboprofilaksa podrazumeva pravovremeno identifikovanje reverzibilnih i ireverzibilnih faktora rizika za venski tromboembolizam (VTE), kao i njihovu kategorizaciju. Podaci da najveći procenat plućnih embolija nastaje kod bolesnika sa nehirurškim oboljenjima i da se kod hirurški lečenih bolesnika VTE uglavnom javlja posle otpusta iz bolnice nameću potrebu za odgovarajućom zaštitom od VTE osoba obolelih od inflamatornih oboljenja, akutnih bolesti i drugih nehirurških oboljenja, kao i produženjem i optimalizacijom antikoagulantnog režima posle hirurških intervencija u primarnoj profilaksi VTE. Kao gotovo potpuno neprepoznate i u praksi zanemarene značajne faktore rizika za VTE posebno ističemo hroničnu opstruktivnu bolest pluća (HOBP) i insuficijenciju srca, naročito kod bolesnika koji pripadaju trećoj i četvrtoj funkcionalnoj klasi prema klasifikaciji Njujorškog udruženja za srce (NYHA III i IV) sa značajno smanjenom funkcijom leve komore. Postoji opasnost da se kod bolesnika sa HOBP znaci dispneje i kašalj jednostrano pogrešno protumače kao tipični simptomi uzrokovani isključivo osnovnom respiratornom bolešću, a da se znaci pogoršanja oboljenja kod osoba s insuficijencijom srca pripišu samo pogoršanju kardijalnog statusa, zanemarujući mogućnost da je u osnovi reč o plućnom tromboembolizmu koji nije na odgovarajući način prepoznat i lečen. Savremeni način života pogoduje nastanku novih faktora rizika za VTE, kao što je 'putnička' tromboza, naročito kod osoba koje lete na dugačkim avionskim linijama, kao i ljudi koji veći deo dana sede ispred kompjutera (engl. e-thrombosis). Utvrđivanje i prepoznavanje faktora rizika za VTE, naročito zanemarenih nehirurških, i istovremenog postojanja višestrukih faktora rizika u određenom vremenskom intervalu neophodno je radi određivanja odgovarajućeg antikoagulantnog terapijskog režima kod bolesnika s nehirurškim oboljenjima i onih koji su hirurški lečeni u primarnoj prevenciji VTE.Adequate thromboprophylaxis primarily requires timely detection of reversible and irreversible risk factors of venous thromboembolism (VTE) and their categorization. It is important to note that the highest percentage of VTE episodes occur in non-surgical (medical) patients and that VTE develops in a large number of surgical patients upon hospital discharge; this emphasizes the need for adequate VTE prevention in inflammatory diseases, acute medical illness and other medical diseases as well as for prolonging and optimizing the anticoagulant regimen after surgical intervention in the primary VTE prophylaxis. As almost completely unrecognized and neglected major risk factors of VTE in clinical practice, we particularly point out the chronic obstructive pulmonary disease (COPD) and heart failure, especially in NYHA functional class III and IV patients with significantly reduced left heart ventricle. It is necessary to raise clinicians' awareness of a potential danger from wrongly and one-sidedly interpreted dyspnea and coughing signs in patients with COPD as typical symptoms of basic respiratory disease as well as from ascribing the signs of disease aggravation in heart failure patients exclusively to cardial status worsening, neglecting the possibility of having unrecognized and untreated pulmonary embolism at issue. Contemporary way of life enhances the development of new VTE risk factors such as traveler's thrombosis, in particular during long-haul flights as well as in individuals sitting at a computer for prolonged periods (e-thrombosis). Determining and recognizing VTE risk factors, especially those formerly neglected nonsurgical ones and simultaneous presence of multiple risk factors within a given period is required for defining an adequate anticoagulant regimen in primary VTE prophylaxis for surgical and non-surgical (medical) patients

A long-period fibre grating sensor for respiratory monitoring

In the current clinical practice of non-invasive mechanical ventilation (NIV), continuous monitoring of respiratory volumes is based on the measurement of air flow through an oronasal mask or mouthpiece. Errors in respiratory-volumes monitoring and patientventilator asynchrony due to the inevitable air leaks from the mask may lead to insufficient ventilation and/or damage of the airway system. Therefore, clinician’s observations of the chest wall expansions are required, but they are subjective, time consuming and strongly dependent on clinician’s experience [1]. We present and validate a method for the measurement of respiratory volumes by a single long period fibre-grating (LPG) sensor of bending. This method is grounded on the hypothesis that the volume of the inhaled air can be correlated with the change in a local torso curvature in a ribs area with stiff underlying tissues. Here, we explain the working principle of the LPG sensors, a monochromatic interrogation scheme, a two-step calibration-test measurement procedure and present results that establish a linear correlation between the change in the local rib-cage curvature and the change in the lung volume. Results also show good sensor accuracy in measurements of tidal and minute respiratory volumes for all clinically relevant breathing volumes [2]. Additionally, we examine the possibility of using the rib-cage movement signal measured by a single LPG sensor as a new way to provide a trigger to the ventilator. Our preliminary results on healthy volunteers provide the statistical evidence of the 200 ms lag of the pneumotechometer with respect to the fibre-optic signal. The proposed single-sensor method is non-invasive, simple, low-cost and easy to implement. Moreover this method does not suffer from the flaws of air-flow measurements, it eliminates the need for chest movement observation by clinicians and can be implemented on both male and female patients. The preliminary results are promising and indicate that the method proposed here could be used in NIV.V International School and Conference on Photonics and COST actions: MP1204, BM1205 and MP1205 and the Second international workshop "Control of light and matter waves propagation and localization in photonic lattices" : PHOTONICA2015 : book of abstracts; August 24-28, 2015; Belgrad

Културни идентитет у немачким мапама пута за централни део европске Турске током векова

Jahrhunderte lang galten Reisewege durch die Balkanhalbinsel als riskant. Zeugnis darüber legt die Reise durch die Gebiete des Drin und Wardar (1867) Johann Georg von Hahns ab. Einem serbischen Kulturkorpus begegnet er unterwegs nirgends. Diesem Umstand nachgehend stellt sich die Frage nach dem Kenntnisstand über die serbische Kulturidentität. Diese soll aus serbischen Forschungen zum Thema Kulturraum Kosovo und Metochien und den dahin gravitierenden Gebieten beantwortet werden und diesbezüglich Fragen der kulturellen Abgrenzung in einem sichtlich weiteren Zusammenhang beleuchten.Путни правци кроз Балканско полуострво вековима су сматрани ризичним. О томе сведочи Јохан Георг Хан у свом Путовању кроз поречину Дрима и Вардара (1867). Пошто нигде не помиње своје сусрете са српском културом, поставља се питање о степену његовог познавања српског културног идентитета. Одговоре на то дају српска истраживања културног простора Косова и Метохије и подручја које њему гравитира, што питања културног разграничења осветљује у знатно ширем контексту

Contribution of novel anticoagulants fondaparinux and dabigatran to venous thromboembolism prevention

The data that episodes and sequels of venous thromboembolism (VTE) are recorded in a significant percentage of patients receiving standard anticoagulants as VTE prophylaxis (unfractionated, low-molecular-weight heparin and vitamin K inhibitors) as well as the fact that these drugs have significant limitations and that they may cause serious side-effects in some patients indicate the need for the introduction of new anticoagulant drugs. Fondaparinux, a selective inhibitor of Factor Xa, administered following major orthopedic surgeries having a high risk for the development of VTE, is more efficient than enoxaparin sodium used in European and North-American approved doses. The increased incidence of major bleeding (excluding fatal) due to fondaparinux could be perhaps lowered by dosage reduction in patients with a mildly decreased creatinine clearance. Dabigatran, a peroral direct thrombin inhibitor, administered for VTE prophylaxis in elective hip and knee surgery, showed in to date studies the efficacy comparable (if dabigatran is given in both dosage regimes of 150 mg and 220 mg daily) or superior (if dabigatran is given at a dose of 220 mg daily) to enoxaparin administered in European-approved doses, while North American-approved doses of enoxaparin were superior than dabigatran in VTE reduction. No significant differences in bleeding rates were determined in any of the study groups. We consider that the introduction of new anticoagulants, including fondaparinux and dabigatran, will contribute to the establishment of a better safety profile and efficacy, and will also enable adequate therapy individualization for each patient depending on his/hers clinical characteristics. The introduction of novel peroral anticoagulants will, inter alia, significantly contribute to improvement in the quality of life, release the patient from numerous limitations in nutrition, interreaction, frequent laboratory monitoring, and also significantly improve therapeutic predictability. [Projekat Ministarstva nauke Republike Srbije, br. 173008: Kompleksne bolesti kao model sistem za proučavanje modulacije fenotipa – strukturna i funkcionalna analiza molekularnih biomarkera

Surgical treatment of symptomatic patellofemoral malalignment: Do we need an ideal patellofemoral congruency to solve the symptoms?

Background/Aim. The aim of this prospective nonrandomized study was to test functional results of different surgical strategies in the operative treatment of symptomatic patellofemoral malalignment. Our hypothesis was that immediate extensive surgery does not have serious advantage comparing to “step by step” procedure, regarding the main symptoms and functional end result. We wanted to check whether obtaining ideal surgical patellofemoral congruency is an essential prerequisite for subsidence of the major symptoms of patellofemoral malalignment. Methods. The study included 35 patients with patellofemoral malalignment who had persistant major symptoms: patellar pain and slipping, 3 months after nonoperative treatment. Divided into three groups, they all underwent the realignment surgery, but in different extent and sequence: immediate extensive surgery, step by step surgery, and only proximal realignment. Their overall functional scores as well as major symptoms were assessed at the beginning, after the surgery, and during the 3-years follow-up period and then, compared at the end. Results. There was no significant difference in the functional results among the groups, neither at the beginning (p = 0.1318) nor at the end of the study (p = 0.3996), but the results at the beginning compared to those at the end of the study showed a statistically significant difference in all three groups (p1 = 0.005062; p2 = 0.011719; p3 = 0.000352). The same result was in regard to the major symptoms. Conclusion. The study confirmed that insisting on immediate extensive surgery in order to achieve precise and complete congruency of the patellofemoral joint, did not prove its advantage over the less invasive, individual surgical approach concerning functional scores and major symptoms

Long-period grating fibre-optic sensors of bending for applications in pulmonology

U ovom radu predstavili smo fiber-optički senzor krivine na bazi rešetke sa dugim periodom i njegovu primenu u praćenju disanja pri mehaničkoj ventilaciji pacijenata. Predložena šema merenja koristi monohromatski izvor svetlosti i fotodiodu kao detektor što je čini ekonomičnom i jednostavnom za upotrebu. Ovde smo demonstrirali primenu senzora u merenju disajnih zapremina koja se zasniva na korelaciji izmenu promene zapremine pluća i promene lokalne krivine torza. Poređenjem rezultata studije na skupu od 15 zdravih dobrovoljaca sa konkurentnim metodima zaključujemo da je predloženi neinvazivni metod pogodan za kliničku praksu.Here we present a fibre-optic sensor of bending and demonstrate its application in monitoring of assisted breathing. The sensor is based on a long-period fibre grating and uses a simple monochromatic interrogation scheme. Here, we first explain the working principle of the sensor and then present a method for the measurement of respiratory volumes. The measurement is based on the correlation between a change in lung volume and the corresponding change in a local torso curvature. We validate the method by applying a calibration-test measurement procedure on a set of 15 healthy volunteers. Results show good sensor accuracy in measurements of the tidal and minute respiratory volumes for clinically relevant types of breathing. Finally, we compare the proposed method with the current clinical standards and competing techniques

Prognostic value of early post-infarction angina in elderly patients

Although numerous studies have shown that early post-infarction angina was a predictor of poor prognosis in patients with acute myocardial infarction, not a single study has considered this issue in the elderly. The goal of this study, based on a five-year follow-up of elderly patients with acute myocardial infarction, was to determine whether early post-infarction angina in the elderly had any influence on mortality and the incidence of additional coronary events. The study population consisted of 51 patients, aged 60 years or more, with acute myocardial infarction. Early post-infarction angina occurred in 31 subjects (Group 1), while it did not in 20 subjects (Group 2). Patients were monitored for five years and the incidences of death and new coronary events were recorded. A survival analysis was carried out using the Kaplan-Meier method. The survival analysis showed no difference between the observed groups concerning the following probabilities: death (p=0.9459), cardiac death (p=0.8253), myocardial reinfarction (p=0.7405), new coronary events (p=0.1708), unstable angina (p=0.1788), myocardial revascularisation (p=0.0691), and heart failure (p=0.7047j. In contrast to the younger population, where numerous studies have confirmed the link between early post-infarction angina and poor long-term prognosis, such findings could not be replicated in this study of the elderly population

The degree of coronary atherosclerosis as a marker of insulin resistance in non-diabetics

Introduction. The metabolic syndrome and its influence on coronary artery disease development and progression remains in focus of international research debates, while insulin resistance, which represents its core, is the key component of hypertension, dyslipidaemias, glucose intolerance and obesity. Objective. The aim of this study was to establish relationship between basal glucose and insulin levels, insulin sensitivity and lipid panel and the degree of coronary atherosclerosis in nondiabetic patients. Methods. The coronary angiograms were evaluated for the presence of significant stenosis, insulin sensitivity was assessed using the intravenous glucose tolerance test with a minimal model according to Bergman, while baseline glucose (G0), insulin (I0) and lipid panel measurements (TC, HDL, LDL, TG) were taken after a 12-hour fasting. Results. The protocol encompassed 40 patients (19 men and 21 women) treated at the Institute for Cardiovascular Diseases of the Clinical Centre of Serbia, Belgrade. All were non-diabetics who were divided into 3 groups based on their angios: Group A (6 patients, 15%, with no significant stenosis), Group B (18 patients, 45%, with a single-vessel disease) and Group C (16 patients, 40%, with multi-vessel disease). Presence of lower insulin sensitivity, higher I0 and TC in the group of patients with a more severe degree of coronary atherosclerosis (insulin sensitivity: F=4.279, p=0.023, A vs. C p=0.012, B vs. C p=0.038; I0: F=3.461 p=0.042, A vs. B p=0.045, A vs. C p=0.013; TC: F=2.572, p=0.09), while no significant difference was found for G0, LDL, HDL and TG. Conclusion. Baseline insulinaemia, more precisely, fasting hyperinsulinaemia could be a good predictor of significant coronary atherosclerosis in non-diabetic patients, which enables a more elegant cardiometabolic risk assessment in the setting of everyday clinical practice