SURGICAL TREATMENT OF THE RHEUMATOID FOOT

Cilj je ovog članka prikazati činjenice vezane uz kirurško liječenje stopala kod pacijenata s reumatoidnim artritisom. Reumatski upalni proces pogađa vezivno tkivo, zglobove, ligamente, tetive, hrskavicu i kosti uzrokujući deformaciju, bol i gubitak funkcije. Osobito je razoran na stopalima. Deformacije zbog reumatoidnog artritisa veće su nego u drugim reumatskim bolestima. Česta deformacija prednjeg dijela reumatoidnog stopala jest haluks valgus. Na metatarzofalangealnim zglobovima ostalih prstiju, osobito drugom, česte su subluksacija i potpuna dislokacija, a na prstima se razvijaju fleksija proksimalnog interfalangealnog zgloba te fleksija ili ekstenzija distalnog interfalangealnog zgloba. Stražnji dio stopala postupno, poslije i u manjoj mjeri biva zahvaćen bolešću. Učinjen je velik napredak u liječenju reumatskih bolesti lijekovima i kirurški. Primjenjuje se nekoliko rekonstruktivnih metoda. Za deformacije prvog traka stopala: artrodeza prvoga metatarzofalangealnog zgloba, Kellerova resekcija ili resekcija Mayova tipa, implantacijska artroplastika, sinoviektomija, osteotomija prve metatarzalne kosti. Za ostale metatarzofalangealne zglobove: tenotomije i produživanje tetiva ekstenzora, otvoreno opuštanje metatarzofalangealnih zglobova, sinoviektomija, resekcija baze proksimalne falange, metatarzalna kondilektomija, resekcija metatarzalne glavice, osteotomija metatarzalne kosti. Za prste: proksimalna interfalangealna resekcija, proksimalna interfalangealna artrodeza, distalna interfalangealna resekcija, stabilizacija prstiju sindaktilijom. Resekcijske artroplastike, skraćujući koštane strukture, poboljšavaju pokretljivost, ali je njihov rezultat nepredvidiv. Za stražnji dio stopala: artrodeza talonavikularnog, suptalarnog, kalkaneokuboidnog zgloba i zgloba gležnja ili aloartroplastika gležnja. Na vrijeme indicirano, dobro planirano i provedeno kirurško liječenje obično daje dobre rezultate. Ono nalaže intenzivnu suradnju pacijenta, reumatologa i ortopeda.The aim of this article is to present certain facts associated with rheumatoid foot surgery. Arthritic disease processes attack the joints, ligaments, tendons, cartilage, and bones, causing deformity, pain, and loss of function. Their effect on the feet can be devastating. Deformities secondary to rheumatoid arthritis are more severe than those in other forms of arthritic diseases. A common deformity of the forefoot is hallux valgus. The lesser metatarsophalangeal joints, especially the second one, commonly show lateral subluxation and total dislocation, and the toes develop flexion of the proximal interphalangeal joint and flexion or extension of the distal interphalangeal joint. The hindfoot is less affected by the disease process, most oft en only in the late stage of the disease. Great progress has been made in the medical and surgical treatment of arthritic diseases. Several reconstructive procedures can be performed. For first ray deformities: first metatarsophalangeal joint fusion, Mayo or Keller resection, implant arthroplasty, synovectomy, proximal osteotomy of the first metatarsal, and metatarsocuneiform fusion. For lesser metatarsophalangeal joints: extensor tenotomies, open metatarsophalangeal joint release, synovectomy, base resection, metatarsal condylectomy, metatarsal head resection, base and metatarsal head resection, and lesser metatarsal osteotomy. For the toes: proximal interphalangeal joint arthroplasty, proximal interphalangeal joint fusion, distal interphalangeal joint arthroplasty, proximal phalangeal base resection, and digital stabilization by syndactylization. Resection arthroplasty improves motion by shortening skeletal structures and providing new gliding surfaces, but the results are unpredictable. For the rheumatoid hindfoot, arthrodesis of the talonavicular, subtalar, calcaneocuboid, and tibiotalar joints or ankle arthroplasty can be performed. The results of a well-planned and performed surgical treatment, indicated in time, are usually good. Co-operation between the patient, rheumatologist, and surgeon is required

Serum proteins and lipids in mild form of calf bronchopneumonia: candidates for reliable biomarkers

Calf bronchopneumonia is complex multifactorial disease and for its accurate diagnosis and therapy, besides clinical examination, microbiologic, hematologic and biochemical analyses could be necessary. In general, additional analyses are not implemented, mainly because the disease biomarkers are not defined. To establish which analysis might be useful for determining the severity of the disease, we analyzed 23 three-month old calves with mild clinical signs of bronchopneumonia and 15 age-matched healthy calves. Pasteurella multocida was isolated from deep nasal swabs of diseased calves. Peripheral blood erythrocyte and leukocyte count of bronchopneumonic and healthy calves showed no difference. Serum proteins, lipoproteins and lipids were analyzed with spectrophotometry, agarose gel electrophoresis, non-reducing SDSPAGE, gel zymography, and thin-layer chromatography. The bronchopneumonic calves had an increased level of circulating immune complexes and a globulins, which contain some of the positive acute phase proteins. In diseased calves the increased concentration of total. globulins (IgG), due to an increased concentration of anionic. globulins (predominately IgG1), was detected. The increased concentration of anionic. globulins followed by increased concentration of transferrin (negative acute phase protein) and HDL cholesterol, decreased concentration of LDL-cholesterol, unchanged activity of matrix metalloproteases and leukocyte counts might reflect the obvious absence of generalized inflammation. A positive correlation was found between the acquired results and the appearance of mild clinical signs. Therefore, we believe that the parameters analyzed in the peripheral blood could be applied as reliable disease markers to distinguish between severe (inflammatory) and mild forms of calf bronchopneumonia and to predict a better outcome for these calves

Application of Solar Activity Time Series in Machine Learning Predictive Modeling of Precipitation-Induced Floods

This research is devoted to the determination of hidden dependencies between the flow of particles that come from the Sun and precipitation-induced floods in the United Kingdom (UK). The analysis covers 20 flood events during the period from October 2001 to December 2019. The parameters of solar activity were used as model input data, while precipitations data in the period 10 days before and during each flood event were used as model output. The time lag of 0–9 days was taken into account in the research. Correlation analysis was conducted to determine the degree of randomness for the time series of input and output parameters. For establishing a potential causative link, machine learning classification predictive modeling was applied. Two approaches, the decision tree, and the random forest were used. We analyzed the accuracy of classification models forecast from 0 to 9 days in advance. It was found that the most important factors for flood forecasting are proton density with a time lag of 9, differential proton flux in the range of 310–580 keV, and ion temperature. Research in this paper has shown that the decision tree model is more accurate and adequate in predicting the appearance of precipitation-induced floods up to 9 days ahead with an accuracy of 91%. The results of this study confirmed that by increasing technical capabilities, using improved machine learning techniques and large data sets, it is possible to improve the understanding of the physical link between the solar wind and tropospheric weather and help improve severe weather forecasting

DISEASE ACTIVITY AND TREATMENT PATTERNS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN CROATIA

Background: Access to biologic treatment diff er in EU countries and is influenced by different factors. In CEE countries 1%–5% of all RA patients are treated with biological therapy. Factors influencing prescriptions of biologics in CEE are mostly macroeconomic conditions and restrictive treatment guidelines but also shortage of specialist prescribers, administrative hurdless and availability of care. [1]. There are published data on access to biologic treatment in Central and Eastern EU countries but there currently is no data in Croatia. Objectives: Th e aim of this study was to assess and compare patient care and access to biologic therapy for rheumatoid arthritis (RA) treated in secondary and tertiary institutions in Croatia. Methods: Non-interventional, multicenter study with retrospective chart review to collect demographics and clinical characteristics from patient’s history and a cross-sectional study on date of visit to the rheumatologist with evaluation of DAS28 score and therapeutic interventions taken at this cross-sectional visit. Study was conducted in 398 RA patients from Balkan region and this subanalysis is showing results on 130 RA patients from 8 sites in Croatia. Results: Results here are obtained from Non-interventional, Multicenter, Cross-sectional Study to Estimate Disease Activity and Treatment Patterns in Patients with Rheumatoid Arthritis in the Balkan Region and assesing information about cros sectional status of DAS28 score and access to biologic therapy in 130 patients from 8 sites in Croatia. Average age was 56.4 years,and 85.4% were female. Results of the DAS28 cross-sectional status showing that 34,6% of patients are in status of moderate and 16% are in active disease. (Fig. 1) Mean time to introduction of biological therapy was 8.2 years. In a total of 28 (21.5%) subjects who had biologic treatment the mean DAS28 score at the time of start of biologic treatment was 5.5 (median 5.45; range 2.7–7.9). The mean time to introduction of biologic terapy was 8.2 years. Conclusions: In this study, a half of patients despite treatment had moderate to active disease. The time to introduction of biologic therapy is very long. Th is clearly show a treatment gap regarding timely introduction of biologic therapy. References: 1. Orlewska E, Ancuta I, Anic B et al. Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE) countries. Med Sci Monit 2011; 17(4): 1–1

The Proposal of the Croatian Society for Rheumatology for the treatment of adult rheumatoid arthritis patients with biologics, 2013

Standardiziran pristup bolesnicima s reumatoidnim artritisom (RA) jedan je od uvjeta dobre reumatološke kliničke prakse. Hrvatsko reumatološko društvo (HRD) Hrvatskog liječničkog zbora (HLZ) ažuriralo je Prijedlog liječenja RA biološkim lijekovima u skladu s novijim spoznajama u reumatologiji kroz posljednje 3 godine. Poštivanjem dogovorenog standarda liječenja izbjegava se nesavjesno liječenje i neracionalna potrošnja, a većini bolesnika pruža veća šansa za povoljan ishod.Standardized approach to the patients with rheumatoid arthritis (RA) is one of the requirements of good clinical practice. Croatian Society for Rheumatology (HRD) of Croatian Medical Association (HLZ) updated the Proposed treatment of rheumatoid arthritis (RA) with biologic agents in line with recent findings in rheumatology for the last 3 years. By complying with the agreed standards of treatment we can avoid malpractice and irrational consumption, and to the most patients provide a greater chance for a favorable outcome