Publisher: Slovenian Academy of Medical Science   (Total: 1 journals)   [Sort alphabetically]

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Zdravniski Vestnik : Slovenian Medical J.     Open Access  
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Zdravniski Vestnik : Slovenian Medical Journal
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1318-0347 - ISSN (Online) 1581-0224
Published by Slovenian Academy of Medical Science Homepage  [1 journal]
  • Per aspera ad astra – lung transplantation

    • Authors: Ivan Kneževič
      Pages: 443 - 445
      Abstract: No abstract..
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3401
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • Lung transplantation in Slovenia – experience in the first three
           years

    • Authors: Matevž Harlander, David Lestan, Matjaž Turel, Mojca Drnovšek Globokar, Elizabeta Špela Mušič, Dejan Pirc, Suada Fileković Ribarič, Michael Gradišek, Boris Greif, Peter Jaksch, Walter Klepetko, Tomaž Štupnik
      Pages: 446 - 452
      Abstract: Background: Lung transplantation is a highly complex treatment method for selected patients with terminal lung disease. With the increase in the number of eligible candidates and the standardization of the technique, it was possible to set up a transplantation centre in University Medical Centre (UMC) Ljubljana in 2018. We report our initial experience. Methods: We analysed the registry of patients with lung transplantation. Patients’ characteristics were compared to the previous group referred to AKH Vienna for lung transplantation. Results: From 15 September 2018 to 15 September 2021, 37 lung transplantations (13 females) were done in UMC Ljubljana. Indications were COPD (n = 13, 35%), pulmonary fibrosis (n = 7, 19%), cystic fibrosis (n = 5, 14%), covid-19 pneumonia (n = 4, 11%), bronchiectasis (n = 3, 8%), pulmonary hypertension (n = 2, 5%), lymphangioleiomyomatosis (n = 1, 3%), alpha-1-antitrypsin deficiency (n = 1, 3%) and bronchiolitis (n = 1, 3%). Compared to previous cohort referred for transplantation to AKH Vienna (71 patients, 35 females), there was higher proportion of patients with COPD (35% vs. 16%, p = 0.019) and the patients were older (median [range], 59 [14 - 68] vs. 43 [4 - 58] years, p = 0.001). 76% of donated lungs did not fit standard donor criteria (30% of donors were older than 55 years, 22% had infiltrates on chest radiographs, and 24% did not meet other criteria). Lung size reduction was required in 43%, which did not result in primary graft failure. Short-term survival was similar in both cohorts of patients (1-year survival in UMC Ljubljana vs. AKH Vienna, 89% [95% CI 78 - 99%] and 83% [95% CI 74 - 92%], respectively). Conclusion: Initial results show similar early lung transplantation outcomes between patients transplanted in UMC Ljubljana or in AKH Vienna.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3342
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • Perinatal prophylaxis with immunoglobulin anti-D and the impact on RhD
           sensitizations among pregnant women in Slovenia

    • Authors: Janja Mrak, Natalija Lehner, Irena Bricl
      Pages: 453 - 461
      Abstract: Background: Sensitizations to red blood cell antigens may be a relevant cause of foetal and neonatal- perinatal morbidity. Of all red blood cell antigens, only alloantibodies to antigen RhD (D) can be prevented during pregnancy using perinatal preventive inoculation with anti-D immunoglobulin (Ig anti-D). Nevertheless, new sensitizations to antigen D among pregnant women are detected. The purpose of this article is to determine the incidence of sensitizations to antigen D among pregnant women in Slovenia in the period from 1 January 2010 to 31 December 2020 and to identify the most likely causes for sensitizations. Methods: We retrospectively reviewed the medical records and the laboratory data in the transfusion information system for pregnant women, in whom we detected antibodies anti-D for the first time, from 1 January 2010 to 31 December 2020. We identified the most likely causes of sensitisation to anti-D from the data. The research was conducted at the Blood Transfusion Centre of Slovenia in Ljubljana (ZTM) and the Centre for Transfusion Medicine at the University Medical Centre Maribor (CTM). Results: We detected 69 new sensitizations to D antigen in the reviewed period, which means that 0.16% of D-negative (D-neg) pregnant women or 0.26% D-neg pregnant women at risk were sensitized. 45% of sensitizations occurred during pregnancy, 29% after childbirth of a D-positive (D-poz) child, 9% after previous abortion. Of the 45% sensitizations during pregnancy, 8 cases (26%) could be prevented, 1 case (3%) could not be prevented, other cases (71%) have most likely occurred as a result of silent foetomaternal haemorrhage (FMK). Of the 38% of sensitizations that occurred after a previous birth or abortion, 4 cases (15%) could be prevented; 2 cases after abortion, 1 case after childbirth abroad, 1 case of refused protection. We could prevent 12 cases (17.5%) of all sensitizations that most likely occurred due to incomplete compliance with the guidelines for preventive inoculation with Ig anti-D (in 2 cases (3%) pregnant women refused protection), 1 case (1.5%) could not be prevented (the pregnant woman did not come to the gynaecologist despite the bleeding). Conclusion: More than 80% of sensitizations occurred despite following guidelines for their prevention; 12 cases (17.5%) could be prevented (7 cases of incomplete perinatal inoculation with Ig anti-D, 1 case of missed postpartum protection and 2 after abortion, 2 cases of refused protection), one case (1.5%) could not be prevented (one pregnant woman did not visit a gynaecologist despite the bleeding). A new measure to prevent sensitization could be routine protection with Ig anti-D in the second trimester of pregnancy and additional educational programs before planning a pregnancy. These programmes should pay particular attention to identifying and responding to potential sensitizing events in pregnancy, blood type D, and the consequences of refusing inoculation with Ig anti-D. Targeted protection represents one of the measures in this area.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3276
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • Protective role of astrocytes in carbon monoxide poisoning and
           optimization of treatment

    • Authors: Ivana Krajnc; dr. med., Laura Kekec, dr. med., Miran Brvar, prof. dr., Damijana Mojca Jurič, znanstv. sod. dr.
      Pages: 462 - 473
      Abstract: Background: Carbon monoxide (CO) poisoning impairs astrocyte and neuron performance. Treatment with hyperbaric oxygen (HBO) can prevent late neuropsychological impairment. We investigated the effect of CO and HBO on the early processes of cell death in neuronal and mixed culture and determined whether the level of glutathione in astrocytes changes after exposure to CO and HBO and whether it could represent a potential new target for the treatment of CO poisoning. Methods: Primary astrocytes, neuronal and mixed cultures of the rat cerebral cortex were exposed to CO in the air and then to 24-hour normoxia, during which the cells were exposed to 100 % oxygen at 3 bar pressure for 1 hour at various time intervals. We measured the activity of lactate dehydrogenase (LDH) and caspase 3/7 in neuronal and mixed cell cultures and levels of glutathione in astrocytes. Results: CO induced an increase in LDH and caspase 3/7 activity in neuronal culture, but only in caspase 3/7 activity in mixed cultures. After treatment with HBO, there was an increase in LDH activity in neuronal and in caspase 3/7 activity in mixed culture. CO caused a decrease in total glutathione (GSHt), an increase in glutathione disulfide (GSSG), and a decrease in GSH/GSSG in astrocytes, and after CO/HBO, there was an increase in GSHt, a decrease in GSSG and an increase in GSH/GSSG. Conclusions: Differences in the cytotoxic effect of CO and the protective role of HBO in neuronal, mixed and astrocyte culture show that neurons growing in the absence of astrocytes are more susceptible to the harmful effects of CO compared to mixed culture and suggest that astrocytes attempt to protect neurons that depend on them for glutathione synthesis during oxidative stress.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3358
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • Patient survival after surgical resection of pelvic bone sarcomas: A
           nationwide cohort study

    • Authors: Aljaž Merčun, David Martinčič, Marko Špiler, Blaž Mavčič
      Pages: 474 - 482
      Abstract: Background: Pelvic bone sarcomas are extremely rare malignant tumours. Patients require a multidisciplinary approach to plan the treatment and complex surgical resections and limb-sparing reconstructions associated with complications, revisions, and functional limitations. The presented nationwide study in the Republic of Slovenia aims to analyse the oncological survival and functional outcomes of patients after primary resection of pelvic bone sarcomas. Methods: The retrospective observational cohort included 21 consecutive patients who underwent limb-sparing pelvic resection at a specialized orthopaedic oncology centre in the Republic of Slovenia between 2004-2022. Patient survival, complication rates, and functional outcomes were analysed according to to the primary diagnosis. Results: Wide margins with R0 resection were achieved in 16 (76%) cases. After a median follow-up of 5.7 (0.6-18.1) years, 7 (33%) patients died of oncological disease, 3 (14%) patients were alive with oncological disease, and 11 (53%) patients were alive with no evidence of disease. The estimated Kaplan-Meier survival probability at 2 years, 5 years, and 10 years after pelvic resection was 85%, 73%, and 45%, respectively. The major complication rate was 29%. The mean Musculoskeletal Tumour Society Score was 17.5 (range 2-29). Conclusions: Patient survival after resection of pelvic bone sarcomas in Slovenia between 2004-2022 is comparable to previously published reports of European and North American countries. Wide resection of tumours with reconstruction provides a relatively good survival rate, although complications are common and functional outcomes are often poor.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3368
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • The electropermeome: cellular response to electroporation

    • Authors: Angelika Vižintin, Damijan Miklavčič; prof. dr.
      Pages: 483 - 495
      Abstract: The increased permeability of a cell membrane due to exposure of cells/tissues to an electric field is called electroporation. Electroporation induces a range of changes in the cell - from structural and chemical changes in the cell membrane, structural changes in proteins or protein complexes, transport of substances in and out of the cell, activation of signalling pathways, and repair mechanisms; it also triggers cell death under certain conditions. The term electropermeome is used to describe both the permeabilised cell during or immediately after the delivery of electrical pulses and all subsequent processes that remain active for some time after the increased transmembrane transport of substances for which the cell membrane is normally impermeable has ceased, i.e. even after the membrane has resealed. Electroporation is used in many areas, including tissue ablation, gene electrotransfer for plasmid delivery into cells and electrochemotherapy. Medical applications of electroporation are effective and safe, but the action of the electrical pulses can cause certain adverse side effects, notably muscle contractions and acute pain. Further elucidation of the underlying mechanisms of electroporation and the effects of individual electric field parameters on the electropermeome is crucial to optimise the parameters of electroporation and consequently the results of electroporation-based therapies. The aim of the present paper is to provide a comprehensive overview of the mechanisms of electroporation and the electropermeome, i.e. the cellular response to electroporation.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3267
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • Cognitive dysfunction in patients with type 2 diabetes

    • Authors: Andreja Špeh; mag. psih, Nika Šatej, dr. med., Andrej Janež, prof. dr., Milica Gregorič Kramberger, doc. dr. med.
      Pages: 496 - 506
      Abstract: The prevalence of diabetes and dementia has been increasing in recent years. These two diseases share many risk factors, such as hypertension, dyslipidaemia, obesity, unhealthy diet, and physical inactivity. Poor glycaemic control is associated with a higher risk of cognitive decline, and both microvascular and macrovascular complications are related to a higher risk of dementia. Older people with diabetes experience deficits in several cognitive domains, especially memory and executive functions. Such problems can affect the course of the disease, individuals’ ability to gain insight into their illness, and the ability to follow a treatment regimen. Cognitive dysfunction in diabetes patients relates to poorer diabetes knowledge and self-care, increased inaccuracies in blood glucose monitoring and insulin adjustment, frequently missed medical appointments, and a higher number of hypoglycaemic episodes and cardiovascular complications. It is important to identify cognitive dysfunction in diabetes patients and consider these problems in treatment planning, defining target glucose levels, planning education, choosing pharmacological and non-pharmacological methods, and providing supports to patients and their family members or caregivers. An individual approach, gradual changes, and a simple treatment regimen (e.g., use of extended-release drugs and pill dispensers) that consider the patient’s social situation are of the utmost importance.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3302
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • Gene therapy in a child with mucopolysaccharidosis type I - Case report of
           the first successful gene treatment of a Slovenian patient abroad

    • Authors: Tadej Jalšovec; dr. med., Benjamin Lah, dr. med., Maria Ester Bernardo, dr. med., Ana Drole Torkar, dr. med., Jana Kodrič, univ. dipl. psih., Mojca Žerjav Tanšek, dr. med., Simona Lucija Avčin, dr. med., Alessandro Aiuti, dr. med., Tadej Battelino, dr. med., Urh Grošelj, dr. med.
      Pages: 507 - 515
      Abstract: Mucopolysaccharidoses are a group of lysosomal storage diseases. Their common feature is the lack of enzymes that break down glycosaminoglycans, polysaccharides that bind to proteoglycans and form the extracellular matrix. Because there are no enzymes that break down glycosaminoglycans, they accumulate in lysosomes and cause damage to them. Consequently, they damage other cellular organelles, cells, and finally, organs. The clinical picture is broad, ranging from neurocognitive decline, musculoskeletal deformities, and coarse facial features. Although we are currently unable to cure the disease, the sooner a diagnosis is made, the better the treatment outcome may be in slowing down the course of the disease. A promising treatment is gene therapy, which suggests the possibility of curing the disease. Early detection of the disease is crucial.
      In this clinical case, we present a boy where early cognitive decline, and signs typical of the disease were identified. He was referred to a tertiary institution, where the diagnosis was confirmed. In July 2018, he underwent experimental gene therapy as part of a clinical study abroad (San Raffaele Hospital, Milan, Italy). To our knowledge, this is the first successfully performed gene therapy in a Slovenian patient and, at the same time, one of the first cases of gene therapy of mucopolysaccharidosis type I on a global scale. Gene therapy has become part of our clinical reality, and it represents an important milestone in the treatment of inborn diseases. It would make sense to introduce newborn screening for MPS type I, which is not yet carried out in Slovenia or Europe. Until then, the most important prerequisite for successful treatment remains early clinical recognition of the disease and referral to a tertiary health care facility.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3328
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • Artificial intelligence for retinal disease management

    • Authors: Maša Koce, Polona Jaki Mekjavič, Mojca Urbančič, Manca Tekavčič Pompe, Mojca Globočnik Petrovič
      Pages: 516 - 524
      Abstract: Image recognition artificial intelligence represents a new milestone in modern medical technology since it has become a helpful tool in identifying suspicious changes and diseases, patient monitoring, and predicting treatment outcomes. Especially through the implementation of convolutional neural networks in the modelling of computer-based artificial intelligence systems, its clinical applicability has recently increased dramatically. Ophthalmology, particularly retinology, where diagnosis almost entirely relies on imaging, is highly technology-driven and as such uniquely positioned to bring AI innovations into clinical use. However, the integration of AI in the screening, diagnosis and treatment of ophthalmic diseases is however still limited, mainly due to the over-generalisation of lesion detection and the poor ability to identify different clinical entities simultaneously. This articleis focused on recent artificial intelligence algorithms and software, which are primarily aimed to support the detection of the most common retinal diseases and have been, or will be - with improved specificity and sensibility, introduced into clinical practice.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3259
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • How did COVID – 19 help implement telemedicine in health care: what were
           the factors that made it possible and how can we use telemedicine to our
           advantage after the pandemic is over

    • Authors: Ula Magdalena Battelino, Eva Turk; doc.dr.
      Pages: 525 - 533
      Abstract: This short review discusses telemedicine and its rapid implementation during the COVID–19 pandemic in the current health care systems. It presents several advantages and potential disadvantages of telemedicine and analyses what COVID–19 pandemic has changed in the existing health care organization to allow for a substantially broader use of telemedicine. It also describes examples of good clinical practice in several healthcare institutions during this pandemic and hypothesises which of these new ideas and organizational solutions that started during COVID–19, would remain useful for the future organization of health care systems.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3264
      Issue No: Vol. 91, No. 11-12 (2022)
       
  • When and how to refer to a rheumatologist

    • Authors: Katja Perdan Pirkmajer, Žiga Rotar, Matija Tomšič, Aleš Ambrožič
      Pages: 534 - 538
      Abstract: In Slovenia, the number of rheumatologists per capita is 40% lower than the European Union average, which can make the implementation of management guidelines challenging. Despite this problem, rheumatologic patients are managed according to international guidelines and comparable with other developed European countries. Unnecessary referrals put additional strain on the overburdened rheumatology outpatient clinics and may ultimately jeopardize the level of care for patients with rheumatological conditions. Herein, we summarized current rheumatology outpatient clinic directions according to different emergency levels.
      PubDate: 2022-12-31
      DOI: 10.6016/ZdravVestn.3287
      Issue No: Vol. 91, No. 11-12 (2022)
       
 
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