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Identification of risk factors influencing Clostridium difficile prevalence in middle-size dairy farms
Petra Bandelj, Rok Blagus, France Briški, Olga Frlic, Aleksandra Vergles-Rataj, Maja Rupnik, Matjaž Ocepek, Modest Vengušt, 2016, izvirni znanstveni članek

Opis: Farm animals have been suggested to play an important role in the epidemiology of Clostridium difficile infection (CDI) in the community. The purpose of this study was to evaluate risk factors associated with C. difficile dissemination in family dairy farms, which are the most common farming model in the European Union. Environmental samples and fecal samples from cows and calves were collected repeatedly over a 1 year period on 20 mid-size family dairy farms. Clostridium difficile was detected in cattle feces on all farms using qPCR. The average prevalence between farms was 10% (0-44.4%) and 35.7% (3.7-66.7%) in cows and calves, respectively. Bacterial culture yielded 103 C. difficile isolates from cattle and 61 from the environment. Most C. difficile isolates were PCR-ribotype 033. A univariate mixed effect model analysis of risk factors associated dietary changes with increasing C. difficile prevalence in cows (P = 0.0004); and dietary changes (P = 0.004), breeding Simmental cattle (P = 0.001), mastitis (P = 0.003) and antibiotic treatment (P = 0.003) in calves. Multivariate analysis of risk factors found that dietary changes in cows (P = 0.0001) and calves (P = 0.002) increase C. difficile prevalence; mastitis was identified as a risk factor in calves (P = 0.001). This study shows that C. difficile is common on dairy farms and that shedding is more influenced by farm management than environmental factors. Based on molecular typing of C. difficile isolates, it could also be concluded that family dairy farms are currently not contributing to increased CDI incidence.
Ključne besede: farm animals, clostridium difficile infection (CDI), dairy farms
Objavljeno: 29.06.2017; Ogledov: 84; Prenosov: 0
.pdf Polno besedilo (1,10 MB)

Factors impacting on the activation and approach times of helicopter emergency medical services in four Alpine countries
Iztok Tomazin, Miljana Vegnuti, John Ellerton, Oliver Reisten, Guenther Sumann, Janko Kersnik, 2012, izvirni znanstveni članek

Opis: Background: The outcome of severely injured or ill patients can be time dependent. Short activation and approach times for emergency medical service (EMS) units are widely recognized to be important quality indicators. The use of a helicopter emergency medical service (HEMS) can significantly shorten rescue missions especially in mountainous areas. We aimed to analyze the HEMS characteristics that influence the activation and approach times. Methods: In a multi-centre retrospective study, we analyzed 6121 rescue missions from nineHEMS bases situated in mountainous regions of four European countries. Results: We found large differences in mean activation and approach times among HEMS bases. The shortest mean activation time was 2.9 minutes; the longest 17.0 minutes. The shortest mean approach time was 10.4 minutes; the longest 45.0 minutes. Short times are linked (p < 0.001) to the following conditions: helicopter operator is not state owned; HEMS is integrated in EMS; all crew members are at the same location; doctors come from state or private health institutions; organization performing HEMS is privately owned; helicopters are only for HEMS; operation area is around 10.000 km2; HEMS activation is by a dispatching centre of regional government who is in charge of making decisions; there is only one intermediator in the emergency call; helicopter is equipped with hoist or fixed line; HEMS has more than one base with helicopters, and one team per base; closest neighboring base is 90 km away; HEMS is about 20 years old and has more than 650 missions per year; and modern helicopters are used. Conclusions: An improvement in HEMS activation and approach times is possible. We found 17 factors associated with shorter times.
Ključne besede: emergency medical services, air ambulances, emergency helicopters, quality of health care, activation and approach time
Objavljeno: 29.06.2017; Ogledov: 114; Prenosov: 0
.pdf Polno besedilo (1,22 MB)

Submicroscopic interstitial deletion of chromosome 11q22.3 in a girl with mild mental retardation and facial dysmorphism: Case report
Danijela Krgović, Nataša Marčun-Varda, Andreja Zagorac, Nadja Kokalj-Vokač, 2011, izvirni znanstveni članek

Opis: Background: Except for terminal deletions that lead to Jacobsen syndrome, interstitial deletions involving the long arm of chromosome 11 are not frequently reported. A clinically distinct phenotype is usually observed in these cases, and no clear genotype-phenotype correlation is proposed. Results: Here we present a case study of a 5-year-old girl with de novo submicroscopic deletion of chromosome 11q22.3 with mild mental retardation and facial dysmorphism. A standard cytogenetic analysis did not reveal any structural aberrations. A contrary array-CGH analysis indicated a small deletion of 11q22.3. Discussion: To our knowledge, this is the smallest 11q22.3 deletion reported in literature, containing nine RefSeq genes. Although none of the deleted genes are obvious candidates for the features observed in our patient, genes CUL5 and SLN could play a key role in the features described.
Ključne besede: 11q22.3 deletion, mild mental retardation, facial dysmorphism
Objavljeno: 29.06.2017; Ogledov: 79; Prenosov: 0
.pdf Polno besedilo (766,41 KB)

An evaluation of SOX2 and hTERC gene amplifications as screening markers in oral and oropharyngeal squamous cell carcinomas
Nadja Kokalj-Vokač, Bogdan Čizmarevič, Andreja Zagorac, Boris Zagradišnik, Boštjan Lanišnik, izvirni znanstveni članek

Opis: Background: Oral and oropharyngeal squamous cell carcinomas (OSCC) are among the most common cancers. The poor survival rate among oral cancer patients can be attributed to several factors, one of them being lack of early detection. A key approach to this problem would be to detect potentially malignant lesion at their early stage. Using the FISH technique, oral brush cytology slides can be an easy and rapid screening approach for malignant cell detection. The present study was designed to detect hTERC and SOX2 amplifications in OSSC exfoliative tumor cells and evaluate whether those two gene amplifications might serve as a supportive biomarker in early detection and diagnosis of oral and oropharyngeal SCC. Results: Brush biopsies were collected from exophytic and exulcerated oral and oropharyngeal lesions of the oral cavity of 71 patients and 22 healthy controls. FISH techniques using a TERC-specific DNA probe and a SOX2 DNA specific probe both combined with a centromere 3-specific control probe was performed on the cytology slides. A 100 squamous epithelial cell nuclei of the smears per slide were analysed. As abnormal FISH pattern were considered amplified and polyploid patterns. From 71 brush biopsies of oropharynx and other locations in oral cavity analysed by FISH 49 were considered to be abnormal (69%). The over representation of polyploidy and/or TERC/SOX2 amplification in tumour samples was statistically significant when compared to controls (p = 0.01). Conclusion: SOX2 and TERC gene amplifications are common in all squamous cell carcinomas and their detection in early stages could be crucial for early detection and more accurate prognosis. Our study strongly suggests that early detection by FISH on cytobrushed samples could be a possible non-invasive screening method even before a tissue biopsy is performed.
Ključne besede: SOX and hTERC gene amplifications, brush biopsy, Oral, oropharyngeal squamous cell carcinoma
Objavljeno: 29.06.2017; Ogledov: 76; Prenosov: 0
.pdf Polno besedilo (1,28 MB)

Comorbidities and characteristics of coronary heart disease patients: their impact on health-related quality of life
Ksenija Tušek-Bunc, Davorina Petek, 2016, izvirni znanstveni članek

Opis: Background: Patients with coronary heart disease (CHD) commonly present with more than one comorbid condition, contributing to poorer health-related quality of life (HRQoL). The aim of our study was to identify the associations between HRQoL and patient characteristics, vascular comorbidities and anxiety/depression disorders. Methods: This observational study was conducted in 36 family medicine practices selected by random stratified sampling from all regions of Slovenia. HRQoL was assessed using the European Quality of Life - 5 Dimensions (EQ-5D) questionnaire and EQ Visual Analogue Scale (EQ-VAS). The associations between HRQoL and patient characteristics stratified by demographics, vascular comorbidities, health services used, their assessment of chronic illness care, and anxiety/depression disorders were identified by ordinal logistic regression and linear regression models. Results: The final sample included 423 CHD patients with a mean age of 68.0 ± SD 10.8 years; 35.2% were female. Mean EQ-VAS score was 58.6 ± SD 19.9 (median: 60 with interquartile range of 45–75), and mean EQ-5D index was 0.60 ± SD 0.19 (median: 0.56 with interquartile range of 0.41–0.76). The statistically significant predictors of a lower EQ-VAS score were higher family physician visit frequency, heart failure (HF) and anxiety/depression disorders (R² 0.240; F = 17.368; p < 0.001). The statistically significant predictor of better HRQoL, according to EQ-5D was higher patient education, whereas higher family physician visit frequency, HF and peripheral artery disease (PAD) were predictors of poorer HRQoL (Nagelkerke R 2 = 0.298; χ 2 = 148.151; p < 0.001). Conclusions: Results of our study reveal that comorbid conditions (HF and PAD), family physician visit frequency and years in education are significant predictors of HRQoL in Slovenian CHD patients.
Ključne besede: coronary heart disease patient, health-related quality of life, vascular comorbidities, anxiety/depression disorders
Objavljeno: 29.06.2017; Ogledov: 78; Prenosov: 1
.pdf Polno besedilo (407,23 KB)

Vasopressin improves outcome in out-of-hospital cardiopulmonary resuscitation of ventricular fibrillation and pulseless ventricular tachycardia: a observational cohort study
Štefek Grmec, Štefan Mally, 2006, izvirni znanstveni članek

Opis: Introduction: An increasing body of evidence from laboratory and clinical studies suggests that vasopressin may represent a promising alternative vasopressor for use during cardiac arrest and resuscitation. Current guidelines for cardiopulmonary resuscitation recommend the use of adrenaline (epinephrine), with vasopressin considered only as a secondary option because of limited clinical data. Method: The present study was conducted in a prehospital setting and included patients with ventricular fibrillation or pulseless ventricular tachycardia undergoing one of three treatments: group I patients received only adrenaline 1 mg every 3 minutes; group II patients received one intravenous dose of arginine vasopressine (40 IU) after three doses of 1 mg epinephrine; and patients in group III received vasopressin 40 IU as first-line therapy. The cause of cardiac arrest (myocardial infarction or other cause) was established for each patient in hospital. Results: A total of 109 patients who suffered nontraumatic cardiac arrest were included in the study. The rates of restoration of spontaneous circulation and subsequent hospital admission were higher in vasopressin-treated groups (23/53 [45%] in group I, 19/31 [61%] in group II and 17/27 [63%] in group III). There were also higher 24-hour survival rates among vasopressin-treated patients (P < 0.05), and more vasopressin-treated patients were discharged from hospital (10/51 [20%] in group I, 8/31 [26%] in group II and 7/27 [26%] group III; P = 0.21). Especially in the subgroup of patients with myocardial infarction as the underlying cause of cardiac arrest, the hospital discharge rate was significantly higher in vasopressin-treated patients (P < 0.05). Among patients who were discharged from hospital, we found no significant differences in neurological status between groups. Conclusion: The greater 24-hour survival rate in vasopressin-treated patients suggests that consideration of combined vasopressin and adrenaline is warranted for the treatment of refractory ventricular fibrillation or pulseless ventricular tachycardia. This is especially the case for those patients with myocardial infarction, for whom vasopressin treatment is also associated with a higher hospital discharge rate.
Ključne besede: vasopressin, antidiuretic hormone, ADH, out-of-hospital cardiopulmonary resuscitation, ventricular fibrillation, pulseless ventricular tachycardia
Objavljeno: 29.06.2017; Ogledov: 48; Prenosov: 0
.pdf Polno besedilo (159,29 KB)

The effect of carbon dioxide on near-death experiences in out-of-hospital cardiac arrest survivors: a prospective observational study
Zalika Klemenc-Ketiš, Janko Kersnik, Štefek Grmec, 2010, izvirni znanstveni članek

Opis: Introduction: Near-death experiences (NDEs) are reported by 11-23% of cardiac arrest survivors. Several theories concerning the mechanisms of NDEs exist - including physical, psychological, and transcendental reasons - but so far none of these has satisfactorily explained this phenomenon. In this study, we investigated the effect of partial pressures of O2 and CO2, and serum levels of Na and K on the occurrence of NDEs in out-of-hospital cardiac arrest survivors. Methods: A prospective observational study was conducted in the three largest hospitals in Slovenia. Fifty-two consecutive patients (median age 53.1 years, 42 males) after out-of-hospital cardiac arrest were included. The presence of NDEs was assessed with a self-administered Greyson's NDE scale. The initial partial pressure of end-tidal CO2, the arterial blood partial pressures of O2 and CO2 and the levels of Na and K in venous blood were analysed and studied. Univariate analyses and multiple regression models were used. Results: NDEs were reported by 11 (21.2%) of the patients. Patients with higher initial partial pressures of end-tidal CO2 had significantly more NDEs (P < 0.01). Patients with higher arterial blood partial pressures of CO2 had significantly more NDEs (P = 0.041). Scores on a NDE scale were positively correlated with partial pressures of CO2 (P = 0.017) and with serum levels of potassium (P = 0.026). The logistic regression model for the presence of NDEs (P = 0.002) explained 46% of the variance and revealed higher partial pressures of CO2 to be an independent predictor of NDEs. The linear regression model for a higher score on the NDE scale (P = 0.001) explained 34% of the variance and revealed higher partial pressures of CO2, higher serum levels of K, and previous NDEs as independent predictors of the NDE score. Conclusions: Higher concentrations of CO2 proved significant, and higher serum levels of K might be important in the provoking of NDEs. Since these associations have not been reported before, our study adds novel information to the field of NDEs phenomena.
Ključne besede: near-death experience, cardiac arrest, survivors
Objavljeno: 29.06.2017; Ogledov: 47; Prenosov: 0
.pdf Polno besedilo (301,05 KB)

The dynamic pattern of end-tidal carbon dioxide during cardiopulmonary resuscitation - difference between asphyxial cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest
Katja Lah, Miljenko Križmarić, Štefek Grmec, 2011, izvirni znanstveni članek

Opis: Introduction: Partial pressure of end-tidal carbon dioxide (PetCO2) during cardiopulmonary resuscitation (CPR) correlates with cardiac output and consequently has a prognostic value in CPR. In our previous study we confirmed that initial PetCO2 value was significantly higher in asphyxial arrest than in ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) cardiac arrest. In this study we sought to evaluate the pattern of PetCO2 changes in cardiac arrest caused by VF/VT and asphyxial cardiac arrest in patients who were resuscitated according to new 2005 Guidelines. Methods: The study included two cohorts of patients: cardiac arrest due to asphyxia with initial rhythm asystole or pulseless electrical activity (PEA), and cardiac arrest due to arrhythmia with initial rhythm VF or pulseless VT. PetCO2 was measured for both groups immediately after intubation and repeatedly every minute, both for patients with or without return of spontaneous circulation (ROSC). We compared the dynamic pattern of PetCO2 between groups. Results: Between June 2006 and June 2009 resuscitation was attempted in 325 patients and in this study we included 51 patients with asphyxial cardiac arrest and 63 patients with VF/VT cardiac arrest. The initial values of PetCO2 were significantly higher in the group with asphyxial cardiac arrest (6.74 +/- 4.22 kPa versus 4.51 +/- 2.47 kPa; P = 0.004). In the group with asphyxial cardiac arrest, the initial values of PetCO2 did not show a significant difference when we compared patients with and without ROSC (6.96 +/- 3.63 kPa versus 5.77 +/- 4.64 kPa; P = 0.313). We confirmed significantly higher initial PetCO2 values for those with ROSC in the group with primary cardiac arrest (4.62 +/- 2.46 kPa versus 3.29 +/- 1.76 kPa; P = 0.041). A significant difference in PetCO2 values for those with and without ROSC was achieved after five minutes of CPR in both groups. In all patients with ROSC the initial PetCO2 was again higher than 1.33 kPa. Conclusions: The dynamic pattern of PetCO2 values during out-of-hospital CPR showed higher values of PetCO2 in the first two minutes of CPR in asphyxia, and a prognostic value of initial PetCO2 only in primary VF/VT cardiac arrest. A prognostic value of PetCO2 for ROSC was achieved after the fifth minute of CPR in both groups and remained present until final values. This difference seems to be a useful criterion in prehospital diagnostic procedures and attendance of cardiac arrest.
Ključne besede: end-tidal carbon dioxide, ETCO2, cardiopulmonary resuscitation, CPR, asphyxial cardiac arrest, ventricular fibrillation, pulseless ventricular tachycardia, cardiac arrest
Objavljeno: 29.06.2017; Ogledov: 55; Prenosov: 1
.pdf Polno besedilo (1,58 MB)

Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting
Gregor Prosen, Petra Klemen, Matej Strnad, Štefek Grmec, 2011, izvirni znanstveni članek

Opis: Introduction: We studied the diagnostic accuracy of bedside lung ultrasound (the presence of a comet tail sign), N-terminal pro-brain natriuretic peptide (NT-proBNP), and clinical assessment (modified Boston criteria) in differentiating heart failure (HF)- related acute dyspnea from pulmonary (COPD/asthma) related acute dyspnea in the prehospital setting. Methods: Prospective study was performed at the Center for Emergency Medicine Maribor, Slovenia, between July 2007 and April 2010. Two groups of patients were compared: HF-related acute dyspnea group (n = 129) vs pulmonary-related (asthma/COPD) acute dyspnea group (n = 89). All patients underwent lung ultrasound examination, along with basic laboratory, rapid NT-proBNP testing and chest X-ray. Results: Ultrasound comet tail sign has 100% sensitivity, 95% specificity, 100% negative predictive value (NPV) and 96% positive predictive value (PPV) for the diagnosis of HF. NT-proBNP (cut-off point 1000 pg/ml) has 92% sensitivity, 89% specificity, 86% NPV and 90% PPV. Boston modified criteria have 85% sensitivity, 86% specificity, 80% NPV and 90% PPV. Comparing the three methods, we found significant differences between ultrasound sign vs NT-proBNP (P<0.05) and Boston modified criteria (P<0.05). Combination of ultrasound sign and NT-proBNP has 100% sensitivity, 100% specificity, 100% NPV and 100% PPV. With ultrasound we can exclude HF in patients with pulmonary related dyspnea who have positive NT-proBNP (> 1000 pg/ml) and previous history of HF. Conclusions: Ultrasound comet tail sign alone or in combination with NT-proBNP has a high diagnostic accuracy in differentiating between acute HF and COPD/asthma causes of acute dyspnea in prehospital emergency setting.
Ključne besede: lungs, ultrasound, N-terminal pro-brain natriuretic peptide, acute heart failure, chronic obstructive pulmonary disease, asthma, acute dyspnea
Objavljeno: 29.06.2017; Ogledov: 60; Prenosov: 1
.pdf Polno besedilo (420,76 KB)

TMPRSS2:ERG gene aberrations may provide insight into pT stage in prostate cancer
Zoran Krstanoski, Nadja Kokalj-Vokač, Andreja Zagorac, Boris Pospihalj, Miha Munda, Sašo Džeroski, Rastko Golouh, 2016, izvirni znanstveni članek

Opis: Background: TMPRSS2:ERG gene aberration may be a novel marker that improves risk stratification of prostate cancer before definitive cancer therapy, but studies have been inconclusive. Methods: The study cohort consisted of 202 operable prostate cancer Slovenian patients who underwent laparoscopic radical prostatectomy. We retrospectively constructed tissue microarrays of their prostatic specimens for fluorescence in situ hybridization, with appropriate signals obtained in 148 patients for subsequent statistical analyses. Results: The following genetic aberrations were found: TMPRSS2:ERG fusion, TMPRSS2 split (a non-ERG translocation) and ERG split (an ERG translocation without involvement of TMPRSS2). TMPRSS2:ERG gene fusion happened in 63 patients (42 %), TMPRSS2 split in 12 patients and ERG split in 8 patients. Association was tested between TMPRSS2:ERG gene fusion and several clinicopathological variables, i.e., pT stage, extended lymph node dissection status, and Gleason score, correcting for multiple comparisons. Only the association with pT stage was significant at p = 0.05: Of 62 patients with pT3 stage, 34 (55 %) had TMPRSS2:ERG gene fusion. In pT3 stage patients, stronger (but not significant) association between eLND status and TMPRSS2:ERG gene fusion was detected. We detected TMPRSS2:ERG gene fusion in 64 % of the pT3 stage patients where we did not perform an extended lymph node dissection. Conclusions: Our results indicate that it is possible to predict pT3 stage at final histology from TMPRSS2:ERG gene fusion at initial core needle biopsy. FISH determination of TMPRSS2:ERG gene fusion may be particularly useful for patients scheduled to undergo a radical prostatectomy in order to improve oncological and functional results.
Ključne besede: FISH, predicting pT stage, radical prostatectomy, prostate cancer, TMPRSS2:ERG fusion
Objavljeno: 29.06.2017; Ogledov: 87; Prenosov: 0
.pdf Polno besedilo (1,06 MB)

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