Giant cell arteritis (GCA) is an immune-mediated vasculitis that affects large arteries. It has been hypothesized that viruses may trigger inflammation within the vessel walls. Genetic studies on ...human leukocyte antigens (HLAs) have previously reported HLA-DRB1*04 as a susceptible allele for GCA and HLA-DRB1*15 as a protective allele for GCA. Here, we discuss the clinical presentation, laboratory findings, HLA class I and class II analysis results, and management of patients with extracranial large-vessel (LV) GCA, detected at least six weeks after recovery from COVID-19. This case series encompassed three patients with LV-GCA (two males and a female with an age range of 63-69 years) whose leading clinical presentation included the presence of constitutional symptoms and significantly elevated inflammatory markers. The diagnosis of LV-GCA was confirmed by CT angiography and FDG-PET/CT, revealing inflammation in the large vessels. All were treated with corticosteroids, while two received adjunctive therapy. By analyzing HLA profiles, we found no presence of the susceptible HLA-DRB1*04 allele, while the HLA-DRB1*15 allele was detected in two patients. In conclusion, LV-GCA may be triggered by COVID-19. We highlight the importance of the early identification of LV-GCA following SARS-CoV-2 infection, which may be delayed due to the overlapping clinical features of GCA and COVID-19. The prompt initiation of therapy is necessary in order to avoid severe vascular complications. Future studies will better define the role of specific HLA alleles in patients who developed GCA following COVID-19.
The main goal of this study was to examine the extent to which different
teaching instructions focused on the application of laboratory inquire-based
experiments (LIBEs) and interactive computer ...based simulations (ICBSs)
improved understanding of physical contents in high school students, compared
to traditional teaching approach. Additionally, the study examined how the
applied instructions influenced students? assessment of invested cognitive
load. A convenience sample of this research included 187 high school
students. A multiple-choice test of knowledge was used as a measuring
instrument for the students? performance. Each task in the test was followed
by the five-point Likert-type scale for the evaluation of invested cognitive
load. In addition to descriptive statistics, determination of significant
differences in performance and cognitive load as well as the calculation of
instructional efficiency of applied instructional design, computed one-factor
analysis of variance and Tukey?s post-hoc test. The findings indicate that
teaching instructions based on the use of LIBEs and ICBSs equally contribute
to an increase in students? performance and the reduction of cognitive load
unlike traditional teaching of Physics. The results obtained by the students
from the LIBEs and ICBSs groups for calculated instructional efficiency
suggest that the applied teaching strategies represent effective teaching
instructions.
Takayasu arteritis (TA) is a rare, large vessel vasculitis that affects aorta, its major branches, and occasionally pulmonary arteries. Patients with TA can present with constitutional features ...and/or various symptoms and signs caused by morphological changes in the blood vessels affected by the inflammatory process. Corticosteroids (CS) and immunosuppressives (IS) are the first line treatment for active TA. Open surgery remains a treatment of choice for TA patients with moderate-to-severe aortic regurgitation (AR) and ascending aortic aneurysm (AAA). We present a 26-year-old female diagnosed with an advanced stage of TA, initially presented as congestive heart failure. Due to a progressive course of the disease (AR 3+, AAA 5.5 cm), surgery of the Aortic valve and root (Bentall procedure), with total arch reconstruction and replacement of supra-aortic branches was performed. The patient has had an uneventful recovery during the postoperative course with no complications at one year follow-up. Normal left ventricle (LV) diameter, LV ejection fraction 67%, and a trace of AR were seen on the last echocardiography.
Takayasu arteritis (TA) is a systemic vasculitis, affecting mainly the aorta and its branches.
To analyze the HLA class I and class II alleles in patients with TA and explore their relationship with ...clinical and demographic characteristics, and potential significance in prognosis.
Twenty-five, unrelated TA patients were genotyped for HLA-A, HLA-B, HLA-C, HLA-DRB1, and the HLA-DQB1 loci. The frequencies of the HLA-A, HLA-B, and the HLA-DRB1 were compared with a control group of 1992, while the HLA-C and the HLA-DQB1 were compared with a group of 159 healthy, unrelated individuals.
Among TA patients, 5/25 (20%) were identified as the HLA-B*52 carriers. There was a significant difference in the HLA-B*52 allele frequency in the TA patients (10%) compared with the healthy controls (1.2%). Moreover, presence of the HLA-B*52 was associated with significantly earlier disease onset, more severe clinical presentations, and a poorer response to treatment. The HLA-C*03 was detected in 32% of patients and was present exclusively in those with a clinically mild form of the TA, indicating a putative protective effect.
These findings indicate that the HLA-B*52 allele contributes to a higher susceptibility to the TA whereas the HLA-C*03, can be a protective factor in the TA.
This research is conducted to determine impacts of tourism development on the demographic image of selected small towns in Serbia. Analyzing the following indicators — tourism potential, the share of ...inhabitants employed in the tourism industry, tourist turnover, and tradition in tourism, the group of 23 small towns is singled out. Further, the selected small towns with dominant tourism function are observed within four tourism clusters. Demographic characteristics of these urban settlements are analyzed through population indicators: total population increase/decrease, age and sex structure, economic activity, education structure, etc., according to the latest available data. The level of local population involvement in tourism is examined, as well as the influence of these small towns on the immediate rural surroundings. The results of conducted analysis show that tourism has an important impact on demographic development in several observed small towns. In the case of other selected small towns, the tourism influence on population increase or migration is stagnating. Despite that, increasing number of employed in the tourism industry is recorded, which implies that tourism is recognized within local community as an activity that could contribute to the development of small towns in Serbia.
Elevated blood lipid level, also known as hyperlipoproteinemia (HLP), is the most common metabolic disorder in the general population. According to US National Heart Institute data, about 36% of ...adults and 10% of children aged 9 to 12 have elevated cholesterol levels. The risk of ischemic heart disease increases by 2-3% with every 1% increase in total cholesterol levels. Therefore, men aged 55-65 with a 10% increase in total cholesterol have about 38% increased ischemic heart disease mortality. The study's main objective is to determine the occurrence of thrombotic complications in patients in whom first-generation drug-eluting stents are implanted and how these events are influenced by the presence of HLP.
The study is retrospective, clinical, and non-interventional with a five-year follow-up period for each patient. Initially, 800 patients undergoing index percutaneous coronary angioplasty with sirolimus-eluting and paclitaxel-eluting stent implantation were enrolled. Clinical data collected included cardiac disorders, the presence of diabetes mellitus, hyperlipoproteinemia, and smoking as a risk factor. In the examined group of patients, stent thrombosis was monitored according to Academic Research Consortium (ARC) criteria.
The study included 800 patients who underwent percutaneous coronary angioplasty index. At the end of the follow-up period, 701 patients (87.6%) completed the clinical trial and were included in the statistical analysis. Stent thrombosis, determined according to ARC criteria, was reported as ‘definitive stent thrombosis’ in 22 patients (3.06%), ‘probable stent thrombosis’ in 1 patient (0.14%), and ‘possible stent thrombosis’ in 1 patient (0.14%). Of the 404 patients with HLP, 120 patients had a total cholesterol value >300 mg/dL. Twenty patients with definitive stent thrombosis had cholesterol >300 mg/dL. Patients with probable and possible stent thrombosis did not have HLP. A comparison of patients with stent thrombosis, with HLP and without HLP, revealed a statistically significant difference (16.67% vs. 1.35%, p <0.001). Comparing patients with unstable angina pectoris, with cholesterol value >300 mg/dL and without HLP, a statistically significant difference was observed (71.7% vs. 17.2%, p <0.001).
We report on the long-term follow up of patients with stent thrombosis after drug-eluting stent insertion with and without HLP. The results suggest that HLP influences the development of coronary disease, with a significant influence on complications following percutaneous coronary intervention.
Patients with acute pancreatitis develop numerous complications and organ damage due to increased intra-abdominal pressure (IAP). These extrapancreatic complications determine the clinical outcome of ...the disease.
A total of 100 patients with acute pancreatitis were included in the prospective cohort study. Observed patients were divided into two groups according to their mean values of IAP (normal IAP values and elevated IAP values), which were compared with examined variables. Patients with intra-abdominal hypertension (IAH) were divided into four groups by IAP values, and those groups of patients were also compared with the examined variables.
Differences between body mass index (BMI) (
= 0.001), lactates (
= 0.006), and the Sequential Organ Failure Assessment (SOFA) score (
= 0.001) were statistically significant within all examined IAH groups. Differences between the mean arterial pressure (MAP) (
= 0.012) and filtration gradient (FG) (
< 0.001) were statistically significant between the first and second IAH groups in relation to the fourth. Differences in diuresis per hour (
= 0.022) showed statistical significance in relation to the first and third groups of IAH patients.
Changes in IAP values lead to changes in basic vital parameters MAP, APP, FG, diuresis per hour, and lactate levels in patients with acute pancreatitis. Early recognition of changes in the SOFA score accompanying an increase in the IAP value is essential.
Introduction. Early assessment of the severity and etiology of acute pancreatitis is very important for further treatment procedures. The aim of the study was to investigate the association between ...intra-abdominal pressure (IAP) and procalcitonin as an indicator of severity of acute pancreatitis. Method. The IAP is measured every 12 hours through the urinary catheter placed in the bladder, in 65 patients with acute pancreatitis. Procalcitonin is measured within 24 hours of receipt of the patient, after 48 hours and after 78 hours. These values of procalcitonin and IAP were compared to each other and in relation to the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system. Patients with APACHE II score > 8 are defined with moderate and severe acute pancreatitis. Results. The values of IAP (18,1 ± 4,5 mmHg vs 8,9 ± 2,67 mmHg; p = 0,01 ), procalcitonin (15,43 + 2,25 ng/ml vs 3,14 + 1,12 ng/ml; p =0,031) and APACHE II scoring system (17,3 ± 6,24 vs 6,5 ± 1,0; p = 0,013) were significantly higher in patients with moderate and severe acute pancreatitis. The increase in the value of IAP was accompanied by an increase in the value of procalcitonin (r = 0,581, p = 0,01). The sensitivity in the prediction of severe acute pancreatitis after 24 hours of receiving the patient is 91,7% for the IAP, 87,8% for procalcitonin and 84,9% for APACHE II scoring system. Conclusion. The increase in the value of the IAP is accompanied by an increase in the values of procalcitonin, also patients with higher values of APACHE II scoring system have higher values of IAP and procalcitonin. The values of IAP and procalcitonin can be used as markers of acute pancreatitis severity.
Nowadays, combating climate change and its effects due to the anthropogenic greenhouse effect is one of the central challenges for society and politics in order to prevent further increase of ...greenhouse gases in the atmosphere and thus become climate neutral. An indispensable prerequisite for the selection, implementation and monitoring of the effectiveness of measures to reduce greenhouse gas emissions is the measurement and accounting of emissions through the implementation of a carbon accounting system. Compared to companies, the topic of carbon accounting at the municipality level has so far received less public attention. Therefore, this paper deals with the specific challenges, the approaches and the perspectives of municipal carbon accounting.
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