Morbidity analysis in a rheumatology clinic by occupation and diagnosis

Izvršena je analiza 425 bolesnika sukcesivno pregledanih u ambulantama Reumatološkog instituta od strane specijalista reumatologa s namerom da se vidi socijalna i medicinska struktura bolesnika koji se upućuju u jednu specijalizovanu reumatološku ustanovu. U radu je analiziran morbiditet te je utvrđeno da se najveći postotak oboljenja odnosi na degenerativne promene kičmenog stuba (46 %). Radnici iz udruženog rada imali su češće degenerativne promene u odnosu na ostale ispitanike, ali su ređe obolevali od zapaljenskog reumatizma. Analizom apsentizma utvrđeno je da su radnici iz proizvodnog rada procentualno više izostajali s posla nego radnici iz administracije. Radnici iz administracije, međutim, bili su češće hospitalizovani od radnika iz proizvodnih zanimanja.An analysis of 425 patients referred to the outpatients department of the Institute for Rheumatology was performed with the intention to find out who these patients were from the social and medical point of view. The analysed group was composed of 192 (45 %) men and 233 (55 %) women with the residence in the city of Belgrade and its suburbs (79.5 %), on the territory of SR Serbia (17.9 %) and in the other republics (2.6 %). The patients were referred mostly by general practitioners (205), specialists (150), and health insurance boards (25), with requests for consultative examinations and hospitalization. Out of the total number of 425 patients, 246 were seen for the first time in the department, 82 were on a regular follow-up and 97 patients had been treated earlier in the department. Among the examined patients there were 175 workers, 68 clerks, 21 farmers, 66 housewives, 82 pensioners and 13 students. The majority were diagnosed as having degenerative spine and disc lesions (196), followed by inflammatory rheumatic diseases (77), peripheral osteoarthrosis (52), extra-articular rheumatism (37), miscellaneous rheumatic conditions (9) and normal findings or nonrheumatic diseases (30). Twenty-four patients, who remained undiagnosed, were in need of further medical investigation and follow-up. Out of the 243 patients employed 166 (68.3 %) were on sick leave and 21 were hospitalized for further treatment and examination

Impairment of acetylcholine-mediated endothelium-dependent relaxation in isolated parotid artery of the alloxan-induced diabetic rabbit

The aim of this study was to assess the effect of type 1 diabetes mellitus (induced by a single intravenous injection of 100 mg kg(-1) of alloxan) on acetylcholine (ACh)-induced relaxation in isolated rabbit parotid gland feeding artery. Isometric force measurements and quantification of inducible nitric oxide synthase (iNOS) mRNA by real-time RT-PCR were made in parotid artery rings from diabetic and control rabbits. Acetylcholine induced concentration- and endothelium-dependent vasorelaxation that was significantly decreased in parotid artery rings from diabetic rabbits. Schild analysis of the ACh vasorelaxant effect, in the presence of selective muscarinic receptor antagonists, revealed involvement of the M(3) receptor subtype in parotid artery rings from both control and diabetic rabbits, with no change in antagonist affinity constants. The inhibitory effects of indomethacin, a non-selective inhibitor of cyclooxygenase, and of high potassium, an inhibitor of hyperpolarization, on ACh vasorelaxation were increased. The effect of N(G)-nitro-L-arginine, a non-selective inhibitor of NOS, was decreased in diabetes. S-methylisothiourea, a selective inhibitor of iNOS, significantly reduced ACh vasorelaxation only in parotid artery rings from diabetic rabbits. Also, up-regulation of iNOS mRNA expression was detected in parotid artery rings from diabetic rabbits. These results suggest that in parotid artery rings from diabetic rabbits, impaired endothelium-dependent vasorelaxation to ACh appears to be caused by the loss of a nitric oxide-mediated component and increased iNOS expression, and is unlikely to be caused by a change at the M(3) receptor level.Ministry of Science and Technological Development, Serbia [175021

Bone microRNA-21 as surgical stress parameter is associated with third molar postoperative discomfort

Objective: To evaluate an association between bone levels of inflammation/oxidative stress mediators and postoperative discomfort after third molar conventional or piezosurgery. Material and methods: Twenty-six subjects with bilaterally impacted mandibular third molars, who underwent either piezo or conventional surgery, were included in a split-mouth design study. MicroRNA-21 (miR-21) expression, interleukin-1 beta (IL-1β), and vascular endothelial growth factor (VEGF) proteins, as well as superoxide dismutase (SOD) activity in alveolar bone, were evaluated. Pain intensity, the first pain appearance, analgesic first use and total dose taken, trismus, and swelling were clinically recorded. Results: MiR-21 expression was higher while VEGF protein was lower in piezosurgery vs. conventional groups. The differences in IL-1β protein and SOD activity were not significant between groups. The pain intensity on the first day was significantly decreased in piezosurgery group. The first pain appearance and the first analgesic taken were reported sooner in conventional vs. piezosurgical group. Significantly pronounced trismus on the third day following conventional surgery was found. In conventional group, significantly increased trismus was observed on the third compared to the first postoperative day. MiR-21 showed significant correlation with the first pain appearance. Conclusion: Delayed onset of less pronounced postoperative pain after piezosurgical vs. conventional extraction of impacted lower third molar was significantly associated with expression of bone miR-21. Clinical relevance: Alveolar bone miR-21 may reflect surgical stress and is associated with third molar postoperative pain onset

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

The conflict in Afghanistan has produced injuries similar to those produced from military conflicts for generations. What distinguishes the modern casualty of the conflict in Afghanistan from those of other conflicts is the effectiveness of modern field medical care that has led to individuals surviving with injuries, which would have been immediately fatal even a few years ago. These patients present several challenges to the reconstructive surgeon. These injured individuals present early challenges of massive soft-tissue trauma, unstable physiology, complex bony and soft-tissue defects, unusual infections, limited reconstructive donor sites, peripheral nerve injuries and traumatic amputations. Late challenges to rehabilitation include the development of heterotopic ossification in amputation stumps. This paper outlines the approach taken by the reconstructive team at the Royal Centre for Defence Medicine in managing these most difficult of reconstructive challenges

Predicting the next pandemic: VACCELERATE ranking of the World Health Organization's Blueprint for Action to Prevent Epidemics

Introduction: The World Health Organization (WHO)'s Research and Development (R&D) Blueprint for Action to Prevent Epidemics, a plan of action, highlighted several infectious diseases as crucial targets for prevention. These infections were selected based on a thorough assessment of factors such as transmissibility, infectivity, severity, and evolutionary potential. In line with this blueprint, the VACCELERATE Site Network approached infectious disease experts to rank the diseases listed in the WHO R&D Blueprint according to their perceived risk of triggering a pandemic. VACCELERATE is an EU-funded collaborative European network of clinical trial sites, established to respond to emerging pandemics and enhance vaccine development capabilities. Methods: Between February and June 2023, a survey was conducted using an online form to collect data from members of the VACCELERATE Site Network and infectious disease experts worldwide. Participants were asked to rank various pathogens based on their perceived risk of causing a pandemic, including those listed in the WHO R&D Blueprint and additional pathogens. Results: A total of 187 responses were obtained from infectious disease experts representing 57 countries, with Germany, Spain, and Italy providing the highest number of replies. Influenza viruses received the highest rankings among the pathogens, with 79 % of participants including them in their top rankings. Disease X, SARS-CoV-2, SARS-CoV, and Ebola virus were also ranked highly. Hantavirus, Lassa virus, Nipah virus, and henipavirus were among the bottom-ranked pathogens in terms of pandemic potential. Conclusion: Influenza, SARS-CoV, SARS-CoV-2, and Ebola virus were found to be the most concerning pathogens with pandemic potential, characterised by transmissibility through respiratory droplets and a reported history of epidemic or pandemic outbreaks