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Visual impairment negatively affects the quality of life of people and it is an important parameter of the outcome of treatment of patients diagnosed with cataracts, glaucoma, strabismus or injuries. The goal of the research was to assess the psychological aspects of the quality of life of patients with the above-mentioned diagnoses.The research included 99 patients of both sexes, who, after surgery at the Clinic for Eye Diseases Tuzla, were monitored on an outpatient basis in the Clinic's Specialist Outpatient Clinic. For the purposes of the research, the Vision Questionnaire (NEI VFQ-25), version 2000, was used.The age of the respondents ranged from 5 to 78 years. The majority of respondents were men 50 (50.50%). The average chronological age of male respondents is 47.50±21.56 years, and female respondents 50.12±20.85. In the total sample, 45.5% of respondents have cataracts, 29.3% glaucoma, 11.1% strabismus and 14.1% have an eye injury. Of these 99 respondents, 47.5% consider their health to be average, 44.4% consider it to be above average, while 8.1% of respondents consider it to be below average. A higher percentage of male respondents have glaucoma (38%) and injuries/trauma (20%) compared to female respondents. A higher percentage of female respondents (55.1%) state that their quality of life is above average, while the percentage of male respondents is 34%. The quality of life is average for 56% of male respondents and 38.8% of female respondents. The results of the chi-square test showed that there is no statistically significant difference in relation to the gender and quality of life of the respondents (χ2= 4.48; df= 2; p= 0.106). The results of the univariate analysis of variance in relation to the cause of visual impairment, and the vision problems experiencedby the subjects showed that there is a statistically significant difference between the subjects in relation to the cause of visual impairment. In relation to the overall results of vision problems, it may be concluded that subjects with cataracts and glaucoma at the statistical significance level of 0.05 state that they have more vision problems compared to subjects with strabismus and injury. Subjects with cataracts at the significance level of 0.05 state that they have more vision problems compared to subjects with glaucoma.Although the self-assessment of the psychological and spiritual components of the quality of life of the subjects gave satisfactory results, it is necessary to provide specific support in order to prevent and eliminate negative reactions to the postoperative condition of operated patients.

Abstract Latent autoimmune diabetes in adults (LADA) is a heterogeneous disease characterized by autoantibodies against insulin producing pancreatic beta cells and initial lack of need for insulin treatment. The aim of the present study was to investigate if individuals with LADA have an altered gut microbiota relative to non-diabetic control subjects, individuals with type 1 diabetes (T1D), and individuals with type 2 diabetes (T2D). Bacterial community profiling was performed with primers targeting the variable region 4 of the 16S rRNA gene and sequenced. Amplicon sequence variants (ASVs) were generated with DADA2 and annotated to the SILVA database. The gut virome was sequenced, using a viral particle enrichment and metagenomics approach, assembled, and quantified to describe the composition of the viral community. Comparison of the bacterial alpha- and beta-diversity measures revealed that the gut bacteriome of individuals with LADA resembled that of individuals with T2D. Yet, specific genera were found to differ in abundance in individuals with LADA compared with T1D and T2D, indicating that LADA has unique taxonomical features. The virome composition reflected the stability of the most dominant order Caudovirales and the families Siphoviridae, Podoviridae, and Inoviridae, and the dominant family Microviridae. Further studies are needed to confirm these findings.

A sensorimotor disorder characterized by a deviation from the parallel position of the eyes is called strabismus, strabismus or strabismus. Strabismus can be non-paralytic, then paralytic (they appear at any age), and concomitant strabismus, the peculiarity of which is that they appear in childhood and are found in 4-6% of the total population. Long-term treatment is required, and it consists of pleoptic methods that include occlusion and exercises for amblyopia, which treat low vision and other sensory complications, and orthoptic methods that refer to: glasses, occlusions, prisms, which establish and maintain the parallelism of the visual axes. After exhaustive conservative treatment, the operative procedure is started. Experience thus far indicates that it is necessary to change and introduce new methods appropriate to the age of a child and the stage to which the treatment has progressed.

ABSTRACTBetween 2019 and 2021, the Autonomous Region of Sardinia and the Eni Enrico Mattei Foundation (FEEM) developed and applied a sustainability assessment model of the investments within the regional operational programmes (ROPs), with specific reference to the United Nations’ 2030 Agenda and its 17 Sustainable Development Goals (SDGs). That same methodology is used here for the assessment of the sustainability of the ROPs co-financed by the European Union with specific reference to Italy’s National Sustainable Development Strategy (NSDS). In particular, the analysis is done by looking at the contribution of the 182 intervention fields to the NSDS’ strategic goals. Throughout the paper the importance of defining implementation strategies of the NSDS’ National strategic goals through the integration of the indicators, goals and choices of the national strategy into local or regional development plans is emphasized. Finally, the work suggests this methodology as a reference point to ensure careful monitoring of the sustainability of the investments of various European Union policies, in consideration of the importance that the strategy assumes for both Italy and the Italian regions.

The aim of this research was to examine the development of motor functions in children with visual impairment compared to children without visual impairment. The research included a sample of 70 respondents; 35 with impaired vision and 35 with no visual impairment. The research was conducted in Sarajevo at the Center for Blind and Visually Impaired Children and Youth “Nedzarici”, and in Tuzla at the Elementary School “Centar”. The results of the research have shown that respondents with visual impairment have less developed motor functions compared to respondents without visual impairment. The variables on which the respondents with visual impairment achieved the worst results, which refer to the quality of drawing and the speed of drawing, were especially singled out.

Aims: The safety and efficacy of insulin analogue insulin aspart (IAsp) have been demonstrated in a randomised clinical trial in pregnant women with Type 1 diabetes (T1D), and IAsp is widely used during pregnancy. The aim of this study was to assess glycaemic control and safety of IAsp versus other bolus insulins in Type 1 diabetic pregnancy in a real‐world setting. Methods: This was a post hoc analysis of a prospective cohort study of 1840 pregnant women with T1D, treated with IAsp (n = 1434) or other bolus insulins (n = 406) in the Diabetes Pregnancy Registry. The primary (composite) outcome was the proportion of pregnancies resulting in major congenital malformations or perinatal or neonatal death. Secondary outcomes included all HbA1c values measured immediately before and during pregnancy and major hypoglycaemia, as well as abortion, pre‐eclampsia, pre‐term delivery, large for gestational age at birth, stillbirth and fetal malformations. Results: There were no significant differences found in any of the pregnancy outcomes between treatment with IAsp and other bolus insulins in either the crude or propensity score‐adjusted analyses. However, maternal HbA1c was lower in the IAsp group at the end of the third trimester (adjusted difference, −0.16% point [95% CI −0.28;−0.05]; −1.8 mmol/mol [95% CI −3.1;−0.6]; p = 0.0046). Conclusions: No significant differences in safety or pregnancy outcomes were demonstrated when comparing treatment with IAsp versus other bolus insulins in women with T1D during pregnancy. The observed improvement in HbA1c with IAsp in late pregnancy should be confirmed in other studies. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the orientation and mobility in children with visual impairment in relation to gender and chronological age. The study included a sample of 35 respondents with visual impairment, aged between 7 and 15. The research was conducted in Sarajevo at the “Centre for Blind and Visually Impaired Children and Youth - Nedžarići” (Bosnian: Centar za slijepu i slabovidnu djecu i omladinu Nedžarići). The results of the research showed that there were statistically significant differences in relation to chronological age obtained on the variables “orientation indoors and in buildings” and “orientation in the yard”, and that there is a relation between orientation and mobility and chronological age on the variables “orientation indoors and in buildings” and “orientation in the yard”. Gender has no significant effect on the orientation and mobility abilities of visually impaired students

Abstract Background Insulin resistance (IR) in skeletal muscle is a key feature of the pre-diabetic state, hypertension, dyslipidemia, cardiovascular diseases and also predicts type 2 diabetes. However, the underlying molecular mechanisms are still poorly understood. Methods To explore these mechanisms, we related global skeletal muscle gene expression profiling of 38 non-diabetic men to a surrogate measure of insulin sensitivity, i.e. homeostatic model assessment of insulin resistance (HOMA-IR). Results We identified 70 genes positively and 110 genes inversely correlated with insulin sensitivity in human skeletal muscle, identifying autophagy-related genes as positively correlated with insulin sensitivity. Replication in an independent study of 9 non-diabetic men resulted in 10 overlapping genes that strongly correlated with insulin sensitivity, including SIRT2, involved in lipid metabolism, and FBXW5 that regulates mammalian target-of-rapamycin (mTOR) and autophagy. The expressions of SIRT2 and FBXW5 were also positively correlated with the expression of key genes promoting the phenotype of an insulin sensitive myocyte e.g. PPARGC1A. Conclusions The muscle expression of 180 genes were correlated with insulin sensitivity. These data suggest that activation of genes involved in lipid metabolism, e.g. SIRT2, and genes regulating autophagy and mTOR signaling, e.g. FBXW5, are associated with increased insulin sensitivity in human skeletal muscle, reflecting a highly flexible nutrient sensing.

Abstract Background Ganglioneuromas (GNs) are extremely rare, slowly growing, benign tumors that can arise from Schwann cells, ganglion cells, and neuronal or fibrous tissues. Due to their origin from the sympathetic neural crest, they show neuroendocrine potential; however, most are reported to be hormonally inactive. Nevertheless, complete surgical removal is recommended for symptom control or for the prevention of potential malignant degeneration. Case Report A 30-year-old female was referred to our oncologic center due to a giant retroperitoneal and mediastinal mass detected in computed tomography (CT) scans. The initial symptoms were transient nausea, diarrhea, and crampy abdominal pain. There was a positive family history including 5 first- and second-degree relatives. Presurgical biopsy revealed a benign ganglioneuroma. Total resection (TR) of a 35 × 25 × 25 cm, 2550-g tumor was obtained successfully via laparotomy combined with thoracotomy and partial incision of the diaphragm. Histopathological analysis confirmed the diagnosis. Surgically challenging aspects were the bilateral tumor invasion from the retroperitoneum into the mediastinum through the aortic hiatus with the need of a bilateral 2-cavity procedure, as well as the tumor-related displacement of the abdominal aorta, the mesenteric vessels, and the inferior vena cava. Due to their anatomic course through the tumor mass, the lumbar aortic vessels needed to be partially resected. Postoperative functioning was excellent without any sign of neurologic deficit. Conclusion Here, we present the largest case of a TR of a GN with retroperitoneal and mediastinal expansion. On review of the literature, this is the largest reported GN resected and was performed safely. Additionally, we present the first systematic literature review for large GN (> 10 cm) as well as for resected tumors growing from the abdominal cavity into the thoracic cavity.

Background and study aim: Endoscopic submucosal dissection is a minimally invasive endoscopic procedure for the removal of neoplastic benign and early malignant lesions in the gastrointestinal tract. In this study, we analyse the success and safety of rectal ESD at Linz hospitals, focusing on a specific endoscopist. Additionally, we examine whether there is a learning curve regarding success parameters. Methods: This retrospective study included all 102 patients who underwent endoscopic submucosal dissection of the rectum by a defined endoscopist at Ordensklinikum Hospital and Kepler University Hospital between December 2010 and May 2021. With the collected data, a descriptive statistic was carried out and regression analyses were performed. Results: The en bloc resection rate was 78.4% and the rate of lesions removed in healthy tissue was 55.6%. The average procedure time was 179 min and the complication rate was 7.8%. In total, 26.4% of cases showed carcinoma; in 25.9% of these cases, an oncologically curative resection was achieved with ESD. Follow-up data were available for 61.1% of cases, with recurrence being diagnosed in 3.6% of cases. A learning curve was observed regarding the rate of lesions removed in healthy tissue and the procedure time, but not regarding the en bloc resection rate. Conclusions: Endoscopic submucosal dissection is a safe method for the removal of large rectal adenomas and early carcinomas. The en bloc resection rate of the analysed procedures is within the range of comparable European studies. The rate of lesions removed in healthy tissue is below the R0 resection rate of the comparative literature; however, a learning curve could be observed in this parameter. [ABSTRACT FROM AUTHOR]

Aims: Combining insulin with a glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) to treat type 2 diabetes (T2D) is common. While many studies have investigated concomitant therapy with basal insulin+GLP‐1RA, few have reported on premixed insulin+GLP‐1RA. We aimed to address this gap using data from the Clinical Practice Research Datalink Aurum database in England. Methods: This retrospective cohort study with propensity score matching assessed glycaemic levels and other clinical outcomes in people with T2D, comparing biphasic insulin aspart 30/70 (BIAsp 30) + GLP‐1RA with basal insulin (insulin detemir/glargine U100) + GLP‐1RA (from 2006 to 2021). Results: In total, 4770 eligible people were identified; 1511 had a BIAsp 30 + GLP‐1RA regimen and were propensity score‐matched to an equal number receiving basal+GLP‐1RA. There was no significant difference in glycated haemoglobin (HbA1c) reduction between cohorts at 6 months (p = 0.15), with a decrease of −1.07 (95% CI: −1.16; −0.98) %‐points (−11.7 mmol/mol [95% CI: −12.7; –10.7]) in the BIAsp 30 + GLP‐1RA cohort, versus −0.97 (95% CI: −1.07; −0.88) %‐points (−10.6 mmol/mol [95% CI: −11.7; –9.6]) in the basal+GLP‐1RA cohort. Body mass index (BMI) decreased by −0.35 kg/m2 (95% CI: −0.52;−0.18) at 6 months with BIAsp 30 + GLP‐1RA, versus −0.72 kg/m2 (95% CI: −0.90;−0.54) with basal+GLP‐1RA (p = 0.003). BMI was influenced by the initiation sequence of GLP‐1RA in relation to insulin (p < 0.0001). Hypoglycaemia rates were low and not significantly different between cohorts. Conclusions: Combining BIAsp 30 + GLP‐1RA provides glycaemic control with no significant difference to that of propensity score‐matched people receiving basal insulin+GLP‐1RA, with no increase in hypoglycaemia risk or weight gain. [ABSTRACT FROM AUTHOR]

Abstract Background Hypoglycaemia, especially nocturnal, remains the main limiting factor of achieving good glycaemic control in type 1 diabetes. The effect of first generation long-acting insulin analogues in reducing nocturnal hypoglycaemia is well documented in patient with type 1 diabetes. The effect of the newer long-acting insulin degludec on risk of nocturnal hypoglycaemia remains undocumented in patients with type 1 diabetes and recurrent severe nocturnal hypoglycaemia. The HypoDeg trial is designed to investigate whether insulin degludec in comparison with insulin glargine U100 is superior in limiting the occurrence of nocturnal hypoglycaemia in patients with recurrent nocturnal severe hypoglycaemia. This paper reports the study design of the HypoDeg trial. Methods/design A Danish investigator-initiated, prospective, randomised, open, blinded endpoint (PROBE), multicentre, two-year cross-over study investigating the effect of insulin degludec versus insulin glargine U100 on frequency of nocturnal hypoglycaemia in patients with type 1 diabetes and one or more episodes of nocturnal severe hypoglycaemia during the preceding two years as the major inclusion criteria. Patients are randomised (1:1) to basal therapy with insulin degludec or insulin glargine. Insulin aspart is used as bolus therapy in both treatment arms. Discussion In contrast to most other insulin studies the HypoDeg trial includes only patients at high risk of hypoglycaemia. The HypoDeg trial will compare treatment with insulin degludec to insulin glargine U100 in terms of risk of nocturnal hypoglycaemic episodes in patients with type 1 diabetes with the greatest potential to benefit from near-physiological insulin replacement therapy. www.clinicaltrials.gov: NCT02192450.

Background: Circumferential pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is a standard of care intervention for patients with symptomatic atrial fibrillation (AF). During follow-up, a substantial number of patients need a redo procedure due to reconnections on the basis of insufficient non-transmural ablation lesions. High-power short-duration ablation (HPSD) is expected to create efficient lesions while causing fewer complications than in conventional RFA settings. The aim of this study was to compare one-year outcome data of very HPSD (90 Watt, 4 s) to a strategy using 50 Watt HPSD ablation guided by the CLOSE protocol using the Ablation Index (AI), an arbitrary unit composed of power, contact force and ablation time. Methods: We retrospectively analyzed short and long-term (median follow-up 23.2 ± 9.9 months) outcome data from 52 patients that were scheduled for first-do-symptomatic PVI. A very HPSD ablation protocol with 90 Watt and a 4 s duration cut-off was compared to an HPSD CLOSE approach (50 Watts; AI 550 at the anterior LA wall; AI 400 at the posterior LA wall, the roof and the floor) in terms of freedom from AF recurrence in a long-term electrocardiogram (ECG) over a five days surveillance period. To gain an impression of the subjective sense of wellbeing, the Atrial Fibrillation Effects on QualiTy-of-Life (AFEQT) score was recorded. Results: Overall freedom from AF was found in 81% (90 W 4 s) vs. 87.5% (50 W), (p = 0.52). There were 3 AF recurrences during the blanking period (90 W 4 s) vs. 1 (50 W). Within each population, one patient was scheduled for a redo-PVI-procedure. The AFEQT score was in favor of the 90 Watt 4 s approach (86.1 vs. 77.5; p = 0.37). Conclusion: Within our relatively small studied population, we found hints that in addition to shortening ablation times and radiation exposure without significantly increasing the rate of relevant intraprocedural complications, very high power short-duration ablation (90 W 4 s) provides comparable efficacy rates after one year.

A 37-year-old man presented with jaundice, upper right quadrant pain, and intermittent fever with chills. Laboratory assessment showed biliary stasis, with total bilirubin of 203 µmol/L (2–20), conjugated bilirubin of 105 µmol/L, and alkaline phosphatase of 556 U/L (30–120). Markers for hepatitis A–E viruses were negative. Serology assessment for rubeola, herpes simplex virus, Epstein-Barr virus, and Toxoplasma gondii showed negative IgM antibodies. HIV serology status was negative. For cytomegalovirus, both types of antibodies (IgM and IgG) were positive, with an IgM level >300 U/mL. pp65 antigen was also detected as well as CMV DNA. Diagnostic imaging of the abdomen except the dilated common bile duct showed a normal appearance of the gallbladder, liver, pancreas, spleen, and both kidneys. To our knowledge, cytomegalovirus cholangiopathy in the absence of any other underlying disease has not been reported. Therefore, the presence of cholangiopathy in our patient is interesting from an imaging, laboratory, and clinical point of view.