Comparison of sevoflurane and propofol anaesthetic regimes in respect to the release of troponin I and cystatin C in off-pump myocardial revascularisation: a randomised controlled trial

Objective. Sevoflurane has been used in cardiac surgery because of its protective effects on the myocardium from ischaemic injury. We wanted to test the hypothesis that sevoflurane has beneficial effects on the heart and kidneys in comparison to propofol. Methods. We conducted a randomised controlled study, with balanced randomization blocked by sex. The participants were 62 patients undergoing off-pump myocardial revascularization (44 men and 18 women), who did not have a myocardial infarction less than 24 hours before the start of the operation and who had normal serum values of troponin I preoperatively. The surgery and the measurements were conducted according to the same protocol for both groups. Propofol was used for the induction of anaesthesia in both groups; anaesthesia was continued with either propofol or sevoflurane. Troponin I and cystatin C plasma concentrations were determined in eight consecutive blood samples, starting before induction of anaesthesia and ending 48 hours after admission to the intensive care unit (ICU). The data were log-transformed and analysed using analysis of variance. Results. We observed a clear and highly statistically significant effect of time for troponin I (p<0.001) without statistically significant differences between the groups (either main or interaction effects). For the majority of patients, the measurements rose quickly upon reperfusion and reached a peak 12 hours after admission to the ICU, descending approximately back to the reperfusion level 48 hours after admission to the ICU. Similar inferences were reached for cystatin C, for which the time-course was approximately bath-shaped. Conclusion. We observed no clear superiority of either sevoflurane or propofol anaesthetic regime in off-pump myocardial revascularisation

Sonographic Evaluation of Pleural Fluid in a Large Group of Adult Healthy Individuals – End Trial Results

This partly prospective, partly retrospective trial was performed in adult healthy volunteers to confirm the prevalence of sonographically visible physiological pleural and to establish possible individual variations of the presence and amount of pleural fluid over time as well as to asses relations in between pleural fluid and individual characteristics like age, sex, body mass index, smoking history and hormone therapy (in woman). A reliable threshold between normal and pathological pleural fluid findings was determined. Prospective chest sonography of both pleural spaces was performed with 3–12 MHz transducer in 71 randomly selected healthy adults and presence of pleural fluid was evaluated and measured as an anechoic layer at least 2 mm in thickness. Each individual was reexamined three times in two to four months intervals. Another 86 individuals were prospectively re-examined for the third time, 24 to 36 months after completed previous trials while the data on the baseline and follow up examination were retrospectively acquired. Maximum thickness of the pleural fluid was measured in the elbow position after five minutes leaning in lateral decubitus position. Examinees served as their own controls, with the quantitative measurement of the fluid layer over time. The fluid layer was visible in at least one pleural space in 51/157 (32.5%) subjects, whereas 35 (22.3%) examinees had a positive finding on all three examinations. Consistency of this finding was high between each pair of examinations over time (Cohen’s Kappa ł0.8, p<0.001). The maximum thickness of fluid layer ranged from 2.0 to 5.2 mm, with a mean of 2.9 mm independently of left or right pleural space and unilateral or bilateral presence. Regression models indicate that odds for observing pleural fluid in an individual decrease with age (p=0.013) and that if observed, the fluid tends to be thicker in women (p=0.017) and in subjects with higher BMI (p=0.028). Sonography detected small amounts of pleural fluid in 32.5% of healthy individuals. If present, maximum thickness of the fluid layer doesn’t exceed the threshold value of 5.2 mm with mean values around 3 mm. The amount of physiological pleural fluid is relative stable over time and is very likely an individual characteristic with lower frequencies in elders while the frequencies of sonographically detected pleural fluid in healthy adults does not correlate with sex, obesity, smoking or hormonal therapy

VizRank: Data Visualization Guided by Machine Learning

Data visualization plays a crucial role in identifying interesting patterns in exploratory data analysis. Its use is, however, made difficult by the large number of possible data projections showing different attribute subsets that must be evaluated by the data analyst. In this paper, we introduce a method called VizRank, which is applied on classified data to automatically select the most useful data projections. VizRank can be used with any visualization method that maps attribute values to points in a two-dimensional visualization space. It assesses possible data projections and ranks them by their ability to visually discriminate between classes. The quality of class separation is estimated by computing the predictive accuracy of k-nearest neighbor classifier on the data set consisting of x and y positions of the projected data points and their class information. The paper introduces the method and presents experimental results which show that VizRank's ranking of projections highly agrees with subjective rankings by data analysts. The practical use of VizRank is also demonstrated by an application in the field of functional genomics

Body Mass Index and Anthropometric Characteristics of the Hand as Risk Factors for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment compressive neuropathy in the upper limbs. It is often correlated with personal factors of individuals, not only with certain medical conditions and jobs. The study aimed at clarifying the association of carpal tunnel syndrome with anthropometric characteristics of the hand and body mass index (BMI) as independent risk factors. A total of 100 subjects participated: 50 patients with electro-diagnostically confirmed CTS and 50 healthy volunteers without CTS symptoms as control group, each group including 37 women and 13 men. Height, weight, BMI, wrist depth and width, wrist index, hand shape index, digit index, palm length, palm width, third finger length and ratio of hand length to body height were assessed in all participants. To determine independent risk factors for CTS, multiple logistic regression was used. Wrist index and wrist width were significantly higher in CTS patients than in the control group. The estimated optimal threshold of wrist index for prediction of CTS was 0.69, above which the odds for CTS were estimated to increase 42-fold. Elevated BMI correlated with bilateral CTS in both genders. The study identified wrist index, BMI and ratio of hand length to body height ratio as independent risk factors for CTS

Time Trends in Prescribing Habits of Anxiolytics and Antidepressants in Slovenian Family Practices (with Emphasis on Elderly Patients)

The aim of the study was to investigate prescription of anxiolytics and antidepressants among Slovenian family physicians regarding drug class with an emphasis on the elderly population and possible time-trends. Exploratory survey and register-based analysis of anxiolytic and antidepressant prescriptions of one hundred family physicians in Slovenia was performed in 2005 and 2008. Drugs included in the study were classified according to the Anatomical-Therapeutic- Chemical (ATC) drug classification system, and ATC data were used to calculate defined daily doses (DDD) per 1,000 practice population per day. The most often prescribed anxiolytics and antidepressants were identified and anxiolytic/ antidepressant ratio was estimation by patient age-group for the two studied years. Benzodiazepines showed highest share in the overall utilization of psychotropic drugs. The ratio between short- and long-acting benzodiazepines decreased by about one tenth during the observed period. Long-acting benzodiazepines were prescribed more often to the older patients. The decrease in anxiolytic/antidepressant ratio from 2005 to 2008 was the smallest in the elderly population. Further research is needed to ascertain the prescribers’ attitudes in order to devise strategies to further improve prescribing performance in elderly patients

PRESCRIBING CHANGES IN ANXIOLYTICS AND ANTIDEPRESSANTS IN SLOVENIA

Background: The ratio of anxiolytics to antidepressants is an indicator of the quality of treatment of depression and anxiety in primary care. The objective of the study was to investigate the prescription of anxiolytics and antidepressants among Slovenian family physicians, including patient demographics and possible time-trends. Subjects and methods: An exploratory survey and register-based analysis of anxiolytic and antidepressant prescriptions in 2005 and 2008 was performed. Drugs included in the study were classified according to an Anatomical-Therapeutic-Chemical (ATC) drug classification system, and ATC data were used to calculate defined daily doses (DDD) per 1,000 practice population per day. Descriptive analysis of anxiolytic/antidepressant ratio by patients’ age, gender and region of residency was performed. Results: Total amount of prescribed antidepressant drugs increased by 45% during the observed 3-year period, while total prescribing of anxiolytics decreased by 14%, leading to the anxiolytics/antidepressants ratio diminishing from 1 to about 0.5. The highest reduction in the ratio was observed in the northeast region, characterised by high social deprivation and one of the highest suicide rates in Europe. The highest prescribing of anxiolytics and antidepressants was observed in the central region around the capital Ljubljana. Conclusions: The reduction of anxiolytic prescribing and increase in antidepressant prescribing indicates improvement in prescribing practice of Slovenian family physicians. There are big variations in prescribing among different Slovenian regions, which are attributable to the number of psychiatrists and access to psychiatric treatment

Značilnosti anamneze o razvoju kronične bolečine

Izhodišča: Trenutno ni veliko znanega o možnih potekih razvoja kronične bolečine, še posebej v odnosu do spremljajočih simptomov (utrudljivost, motnje spanja). Iz klinične prakse in nekaterih raziskav vemo, da bolniki z dolgoletno kronično bolečino poročajo še o drugih težavah, predvsem na področjih spanja in splošne vitalnosti, kar poleg bolečin pomembno vpliva na celostno življenjsko delovanje. V klinični praksi je anamneza glavno orodje opredeljevanja kroničnega bolečinskega sindroma. Z raziskavo smo želeli analizirati podatke, ki se rutinsko zbirajo neposredno ob kliničnem delu, predvsem pa ugotoviti obstoj morebitnih vzorcev glede na anamnezo razvoja časovnega sosledja omenjenih težav in raziskati morebitne razlike med tako nastalimi skupinami. Metode: Vključili smo 487 zaporedno pregledanih polnoletnih bolnikov, napotenih v subspecialistično ambulanto za rehabilitacijo oseb s kronično nerakavo bolečino od februarja do novembra 2019. Za opredelitev načina nastanka in časovnega poteka razvoja težav smo uporabili 16 dvojiških opisovalcev. Udeleženci so izpolnili tudi vprašalnika o bolečini. Uporabili smo še podatke, ki jih rutinsko pridobivamo v sklopu timskega triažno ocenjevalnega pregleda: o predhodnih in pridruženih boleznih, testiranjih gibalnih sposobnosti, indeksu telesne mase, prejemanju zdravil in socialnoekonomskem statusu. Rezultati: O pojavu prvih trajnih bolečin so udeleženci največkrat poročali v predelu ledvene hrbtenice. Tretjina udeležencev je navajala oceno trajanja bolečine vsak dan do 5 let, kar 16 % pa preko 20 let. Le tretjina udeležencev ni poročala o sočasnem glavobolu. Za večino udeležencev v raziskavi je bila bolečina glavna zdravstvena težava. S hierarhičnim združevanjem v skupine na podlagi opisovalcev smo prepoznali 3 izrazite skupine: 1. bolečina se je razvila praviloma postopno, v odrasli dobi se je iz iz t.i. področne bolečine razvila v razširjeno, utrudljivost in motnje spanja pa so se pojavili s širjenjem bolečinskih simptomov; 2. bolečina se je razvila že v otroštvu ali t.i. nenadno po poškodbi, spremljajoče težave pa so se razvile po nastopu simptoma bolečine; 3. telesna utrudljivost se je razvila pred pojavom telesnih bolečin, ki so se razvile praviloma postopno, iz področne oz. regionalne bolečine v razširjeno. Glede pojavljanja glavobolov izstopa le skupina 2, kjer se le-ti praviloma pojavijo kasneje. V 4. skupini so bili udeleženci z nejasno anamnezo. Podatki o pridruženih boleznih so razkrili širok nabor bolezenskih stanj, ki jih navadno neposredno ne povezujemo z bolečinskimi sindromi. Med pridruženimi boleznimi poleg motenj razpoloženja izstopajo še bolezni ščitnice in ginekološke bolezni. Med skupinami smo na podlagi zbranih kliničnih podatkov zaznali nekatere pomembne razlike. Zaključek: Razkrili smo možne vzorce za razvoj kroničnega bolečinskega sindroma glede na anamnezo časovnega sosledja razvoja temeljnih simptomov (bolečina po telesu, glavobol, telesna ali umska utrudljivost, motnje spanja), kar bi bilo v prihodnosti smiselno raziskovati z vidika posebnosti patofizioloških mehanizmov v ozadju opisanih vzorcev in za ukrepe primarne ali sekundarne preventive ter zdravstvene oskrbe najbolj prizadetih

Sonographic Evaluation of Pleural Fluid in a Large Group of Adult Healthy Individuals – End Trial Results

This partly prospective, partly retrospective trial was performed in adult healthy volunteers to confirm the prevalence of sonographically visible physiological pleural and to establish possible individual variations of the presence and amount of pleural fluid over time as well as to asses relations in between pleural fluid and individual characteristics like age, sex, body mass index, smoking history and hormone therapy (in woman). A reliable threshold between normal and pathological pleural fluid findings was determined. Prospective chest sonography of both pleural spaces was performed with 3–12 MHz transducer in 71 randomly selected healthy adults and presence of pleural fluid was evaluated and measured as an anechoic layer at least 2 mm in thickness. Each individual was reexamined three times in two to four months intervals. Another 86 individuals were prospectively re-examined for the third time, 24 to 36 months after completed previous trials while the data on the baseline and follow up examination were retrospectively acquired. Maximum thickness of the pleural fluid was measured in the elbow position after five minutes leaning in lateral decubitus position. Examinees served as their own controls, with the quantitative measurement of the fluid layer over time. The fluid layer was visible in at least one pleural space in 51/157 (32.5%) subjects, whereas 35 (22.3%) examinees had a positive finding on all three examinations. Consistency of this finding was high between each pair of examinations over time (Cohen’s Kappa ł0.8, p<0.001). The maximum thickness of fluid layer ranged from 2.0 to 5.2 mm, with a mean of 2.9 mm independently of left or right pleural space and unilateral or bilateral presence. Regression models indicate that odds for observing pleural fluid in an individual decrease with age (p=0.013) and that if observed, the fluid tends to be thicker in women (p=0.017) and in subjects with higher BMI (p=0.028). Sonography detected small amounts of pleural fluid in 32.5% of healthy individuals. If present, maximum thickness of the fluid layer doesn’t exceed the threshold value of 5.2 mm with mean values around 3 mm. The amount of physiological pleural fluid is relative stable over time and is very likely an individual characteristic with lower frequencies in elders while the frequencies of sonographically detected pleural fluid in healthy adults does not correlate with sex, obesity, smoking or hormonal therapy

Premature Mortality in Slovenia in Relation to Selected Biological, Socioeconomic, and Geographical Determinants

Aim: To determine biological (sex and age), socioeconomic (marital status, education, and mother tongue) and geographical (region) factors connected with causes of death and lifespan (age at death, years-of-potential-life-lost, and mortality rate) in Slovenia in the 1990s. Methods: In this population-based cross-sectional study, we analyzed all deaths in the 25-64 age group (N = 14 816) in Slovenia in 1992, 1995, and 1998. Causes of death, classified into groups according to the 10th revision of International Classification of Diseases, were linked to the data on the deceased from the 1991 Census. Stratified contingency-table analyses were performed. Years-of-potential-life-lost (YPLL) were calculated on the basis of population life-tables stratified by region and linearly modeled by the characteristics of the deceased. Poisson regression was applied to test the differences in mortality rate. Results: Across all socioeconomic strata, men died at younger age than women (index of excess mortality in men exceeded 200 for all studied years) and from different prevailing causes (injuries in men aged 35 years). For men, higher education was associated with fewer deaths from digestive and respiratory system diseases. The least educated women died relatively often from circulatory diseases, but rarely from neoplasms. Single people died from neoplasms less often. Marriage in comparison with divorce reduced the mortality rate by 1.9-fold in both men and women (P<0.001). Mortality rate in both men and women decreased with increasing education level (P<0.001). Mortality rate of ethnic Slovenians was half the mortality rate of ethnic minority members and immigrants (P<0.001). Analysis of YPLL revealed limited and nonlinear impact of education level on premature mortality. The share of neoplasms was the highest in the cluster of socioeconomically prosperous regions, whereas the share of circulatory diseases was increased in poorer regions. Significant differences were found between individual regions in age at death and mortality rate, and the differences decreased over the studied period. Conclusion: These data may aid in understanding the nature, prevalence and consequences of mortality as related to socioeconomic inequalities, and thus serve as a basis for setting health and social policy goals and planning health measures