Publishing frequency: twice a year. Editor-in-Chief: Prof. Dušica Pahor, MD, PhD The Acta Medico-Biotehnica is the official journal of the Faculty of Medicine, University of Maribor in Slovenia. The scientific-professional journal contains material of interest to a wider readership covering the medical and biotechnical fields. The Papers are peer reviewed by an international Editorial Board. Indexing: EBSCO, DKUM, COBISS, dLib, Ulrich's Periodical Directory Licence: CC BY
Address of Rector Prof. dr. Zdravko Kačič on Rector’s Day at University of Maribor
Revered Guest Rectors and Vice-Rectors of Slovenian universities, Revered Academic Community of the University of Maribor: Prize Winners, Vice Rectors, Deans of Faculties, Emeritus Professors and Retired Professors, Teachers, Researchers and Associate Experts, Students, Ladies and Gentlemen! This year is a special Jubilee year for the University of Maribor. Fifty years ago, on September 18, 1975, “a second Slovenian university was solemnly proclaimed upon the sound of a fanfare in an assembly of distinguished guests and locals.” With today’s ceremony, we begin a year-long celebration to mark the 50th anniversary of the founding of the University of Maribor.
Copyright (c) 2025 Zdravko Kačič (Author) https://creativecommons.org/licenses/by/4.0
Comparative evaluation of fresh and freeze-dried 3D-printed wound dressings with Plantago major extract
Aim: In this study, we prepared an extract of Plantago major L. (PM) herb and assessed its safety and impact on fibroblast metabolic activity (MA) across a broad concentration range. Additionally, we examined the effects of dry and fresh three dimensionally (3D)-printed wound dressings (abbreviated: dressing) on fibroblasts and evaluated their influence on cell migration and proliferation by a scratch assay. Methods: We prepared a methanolic PM extract and investigated its effect on fibroblast MA across various concentrations. Using 3D printing, we fabricated dressings composed of methylcellulose, alginate, and nanofibrillated cellulose, incorporating the extract. Subsequently, we assessed the effects of dry and fresh dressings on fibroblast MA as well as on migration/proliferation by a scratch assay. Results: T he e xtract h ad n o c ytotoxic e ffects a t c oncentrations of 1–1,000 μg/mL, but became cytotoxic at 10,000 μg/mL. Fibroblast MA increased up to a concentration of 1,000 μg/mL, after which it began to decline, indicating a hormetic effect. The dry dressing enhanced fibroblast MA 1.2-fold more than the control (normalized to 1.0) and the fresh dressing (0.99-fold). The scratch assay confirmed that both dressings supported fibroblast migration/proliferation equally. Conclusions: Our in vitro results support the traditional use of PM in wound healing and can serve as a basis for future investigation of this plant in clinical trials.
Copyright (c) 2025 Laura Činč Ćurić, Uroš Maver, Tina Maver (Author) https://creativecommons.org/licenses/by/4.0
The application of computednanotomography in biomedical sciencesand medicine
Background: Computed nanotomography (nano-CT) is a cutting-edge imaging technology that provides ultra-high-resolution three-dimensional (3D) visualization at the cellular and subcellular levels, significantly surpassing conventional computed tomography (CT) and other imaging modalities. In this review, we describe the technological development of nano-CT along with its current capabilities and potential for integration into clinical medicine. Methods: We reviewed the existing literature relating to nano-CT technology, emphasizing biomedical research applications and evaluating potential for future clinical integration. Results: Nano-CT has demonstrated exceptional utility across various biomedical disciplines, including cardiology, vascular medicine, neurology, pulmonology, oncology and dentistry. This imaging technique provides unprecedented insights into tissue architecture, cellular details and pathological processes, providing significant enhancement in our understanding of diseases and supporting advancements in diagnosis, treatment planning, and therapeutic strategies. Conclusions: Despite remarkable potential for biomedical research, the clinical adoption of nano-CT faces several challenges, including limitations in imaging speed, soft tissue contrast, radiation dose and sample size. Continued technological innovations, clinical validation, and the development of multimodal imaging approaches are essential for the successful transition of nano-CT into routine medical diagnostics and personalized medicine.
Copyright (c) 2025 Jernej Vajda, Marko Milojević, Uroš Maver, Boštjan Vihar (Author) https://creativecommons.org/licenses/by/4.0
Management and treatment of children with chronic kidney disease
Chronic kidney disease (CKD) is defined as a disorder of kidney function or structure that is present for more than 3 months and has a significant impact on health with the risk of progressive loss of kidney function. New recommendations for the management of patients with CKD have recently been published. The basic management of children with CKD includes promoting a healthy lifestyle, preventing the progression of CKD, treating associated complications, and preparing the patient and their family for renal replacement therapy if needed. Maintaining a healthy lifestyle includes close monitoring of kidney function and potential complications, monitoring growth, nutrition, neurological development, and blood pressure. In the context of preventing the progression of CKD, it is important to treat the underlying disease, if possible, and prevent further acute kidney injury. Well-controlled blood pressure as well as proteinuria have been shown to slow the progression of kidney disease in children, and are therefore vital. CKD significantly affects the quality of life of a child and his family. Comprehensive treatment of a child includes treatment by a multidisciplinary team that works proactively.
Copyright (c) 2025 Mirjam Močnik, Nataša Marčun Varda (Author) https://creativecommons.org/licenses/by/4.0
Management of newborns with congenital heart defects in Northeast Slovenia: a single-center retrospective study
Purpuse: To compare the epidemiological and clinical characteristics between critical and noncritical congenital heart defects (CHD), and the detection rate of CHD, time of intervention, and outcomes in Slovenia and globally. Methods: We performed a retrospective observational study of 353 neonates with CHD who were born in the maternity ward at the University Medical Center Maribor between 2018 and 2022. Data were collected from the database at the University Medical Center Maribor and from personal patient files. We compared maternal and infant characteristics between critical and noncritical CHD. The detection rate of CHD, time of intervention, treatment options, and outcomes were also compared among infants with CHD. Results: The overall incidence of critical CHD was 1.75/1,000 live births, while the incidence of major CHD was 4.4/1,000 live births. Genetic abnormalities were found in 21.4% (n = 3) of children with critical CHD. Critical CHD was identified prior to the patient being released from the maternity ward in 85.7% (n = 12) and after discharge in 14.3% (n = 2). All critical CHD cases were identified based on clinical condition and confirmed by echocardiography. The absence of a heart defect was detected by newborn pulse oximetry screening. A total of 27.5% (n = 97) of pregnancies were affected by gestational diabetes (GDM). Conclusions: The management of newborns with CHD requires a trained multidisciplinary medical team, as early recognition improves morbidity and prevents mortality. Most CHDs are detected based on clinical conditions, with the diagnosis being confirmed by echocardiography. While the detection of CHD was satisfactory, some newborns with critical CHD were undiagnosed and discharged from the maternity ward. The proportion of undetected infants with CHD may increase in the future if the trend toward earlier discharge continues.
Copyright (c) 2025 Teja Senekovič Kojc, Tjaša Barbič, Mirjana Miksić✝ (Author) https://creativecommons.org/licenses/by/4.0
Validation of the Slovenian version of the Patient-Practitioner Orientation Scale – PPOS
Purpose: Recent decades have seen the emergence of a healthcare framework that places the patient at the core, giving rise to a novel approach termed patient-centered care (PCC) which emphasizes the importance of understanding and respecting the individual needs, values, and preferences of patients, while promoting active collaboration between patients and healthcare providers at all levels. This approach also addresses the psychological, social, and spiritual needs of patients. Several questionnaires have been developed to measure PCC, among which Krupat’s *Patient-Practitioner Orientation Scale* (PPOS) is frequently used. Methods: Validation of the PPOS questionnaire was conducted in several phases. The translation followed the recommendations of the World Health Organization and the ISPOR guidelines. The process included: translation of the questionnaire into Slovenian by two independent translators, review and harmonization of the translations by experts in the field of family medicine, back-translation of the questionnaire into English, and cultural validation of the questionnaire’s appropriateness. The questionnaire was distributed via email to participating family medicine physicians. This was followed by exploratory factor analysis of the data and an assessment of the scale’s internal consistency. Results: The questionnaire was completed by 112 family physicians of various ages, working in different environments and practice sizes. Only items 9 and 13 in the questionnaire met the criterion of being “patient-oriented.” “Moderate patient orientation” was observed in item 17. All other items met the criterion of being “practitioner-oriented.” Exploratory factor analysis identified four factors within the scale. The reliability of each of the four factors was assessed. The calculation of Cronbach’s alpha showed acceptable internal consistency for the entire questionnaire (0.724), as well as for factor 1 (0.709) and factor 2 (0.688). For the other two factors, however, low internal consistency was observed (factor 3 = 0.437, factor 4 = 0.437). Conclusion: The analysis of the results revealed a predominant orientation toward the practitioner. The validation process showed that the Slovenian translation of the questionnaire in its current form is not yet suitable for use. Further adjustments and additional validation are needed to ensure that the questionnaire becomes an appropriate tool for assessing PCC in the Slovenian context.
Patient- Practitioner Orientation Scale (PPOS)
Copyright (c) 2025 Ksenija Tušek Bunc (Author) https://creativecommons.org/licenses/by/4.0
Catheter-directed thrombolytic therapy for lowerextremity deep vein thrombosis: a case report
Patients with lower-extremity deep vein thrombosis commonly present to emergency departments. However, the propagation of deep vein thrombosis to phlegmasia cerulea dolens is rarely seen. Catheter-directed thrombolytic therapy is widely accepted as an appropriate treatment for severe forms of lower-limb deep vein thrombosis such as phlegmasia cerulea dolens. It is usually available only in a few selective hospitals. This study aimed to present a case of the first such procedure performed in the University Medical Centre Maribor.
catheter-directed thrombolysis; deep vein thrombosis; percutaneous interventional treatment; phlegmasia cerulea dolens
Copyright (c) 2022 Aja Pajnik Snoj, Andrej Markota https://creativecommons.org/licenses/by/4.0
Modern technologies enable treatment planning and the fabrication of clear aligners for the correction of misaligned teeth
Purpose: This article reports the realignment of teeth with clear aligners (CA) made using a modern technique manufactured entirely in Slovenia. Case report: A 34-year-old man visited the Orthodontic Department of our healthcare centre because of misaligned teeth in the mandibular arch. The goal of treatment was to align the mandibular anterior teeth using a Slovenian-made CA. The procedure began with an impression for the working cast that was scanned and a 3D image of the patient's dental arches and occlusion were created in the computer. A software package was used to create a 3D virtual model,and the teeth were virtually placed in the positions that would be achieved during treatment with the CA. The CA were made of an elastic thermoplastic material (polyurethane). The patient was instructed to wear the appropriate aligner for 22 hours daily and change it every two weeks. Dental crowding was corrected in six months and at the end of treatment a lingual fixed retainer was bonded to prevent relapse. The patient was very satisfied with the result. After two years of retention, the results remain stable. Results: Comparable to a conventional fixed appliance, a CA is a removable device that offers better aesthetics, more comfort and better oral hygiene.
clear aligners, tooth alignment, digitization, additive manufacturing
Copyright (c) 2022 Anita Fekonja, Nejc Rošer, Igor Drstvenšek https://creativecommons.org/licenses/by/4.0
Hemorrhagic stroke in children: A case report
Purpose: The purpose of this report is to present a case of hemorrhagic stroke in a child. Case report: We present a 13-year-old child with a hemorrhagic stroke, which resulted from spontaneous bleeding of congenital arteriovenous malformations in the brain. Conclusion: Although a brain stroke in children is rare, it is an important cause of disability and mortality. Clinical, neurologic, and radiologic examinations are key for the detection and treatment of arteriovenous malformations, which are the most important cause of hemorrhagic stroke in children and may threaten a child's health and life.
hemorrhagic stroke, arteriovenous malformation, treatmen
Copyright (c) 2022 Tanja Dukić Vuković, Mirjana Miksić, Tomaž Šeruga, Janez Ravnik https://creativecommons.org/licenses/by/4.0
Systemic risk factors in patients younger than 50 years with retinal vein occlusionsl
Purpose: To identify the etiological factors of patients with retinal vein occlusion (RVO) younger than 50 years. Methods: The clinical records of patients with RVO under the age of 50 years seen between January 2015 and December 2020 were analyzed retrospectively. Past medical history, drug use, thrombophilic features, hyperviscosity syndromes, and pathologies that may have caused vasculitis were noted. All patients underwent ocular and systemic examinations, as well as complete screening for thrombophilic risk factors. Results: A total of 20 patients (22 eyes) were recruited in the study, 14 (70%) of whom were male and seven (30%) were female. The mean age was 42 years. The diagnosis was central retinal vein occlusion (CRVO) in 12 eyes (60%) and branch retinal vein occlusion (BRVO) in 10 eyes (40%). Two patients had bilateral BRVO. Hypertension was determined in eight (38%) patients, diabetes mellitus in two (9.5%) patients, and dyslipidemia in 11 (52%) patients. Mutation of factor V Leiden was found in one (5%) patient. An ocular risk factor was pigmentary glaucoma in two (10%) patients. Other diseases that were also noted included Behcet's (5%) and Eale's disease (5%). Multiple etiological factors were detected in 10 (48%) patients. No risk factors were found in only four (19%) patients. Conclusion: Dyslipidemia was the most prevalent risk factor for RVO. Work-up for the etiology of RVO in younger patients may reveal nontraditional risk factors for retinal vein occlusion. It was particularly interesting that thrombophilic disorder was found in only one female CRVO patient. Etiological factors that might result in RVO in young individuals should therefore be investigated in detail.
etinal vein occlusion, risk factor, dyslipidemia, thrombophylia
Copyright (c) 2022 Katja Kuhta, Katarina Petelin, Matejka Masten, Nina Košič Knez, Dušica Pahor https://creativecommons.org/licenses/by/4.0
Achievements in surgical treatment for colorectal liver metastases from 2000 until 2020
Purpose: Colorectal cancer represents the third most frequently occurring malignant disease worldwide that most often disseminates into the liver. The present report describes the treatment possibilities and results of a surgical approach to treat colorectal liver metastases (CLM). Methods: A retrospective review of a prospectively maintained database of patients who underwent surgical treatment for CLM at the Clinical Department of Abdominal and General Surgery of University Medical Centre Maribor in Slovenia was performed. The study was based on the intention-to-treat principle. All procedures, redo procedures, morbidity, and survival were analyzed. Results: The study covered the period between January 2000 and December 2020, during which 631 surgical liver procedures were performed. A total of 352 (74.4%) patients underwent a single procedure, and 121 (25.6%) patients had more than one procedure. The largest portion of surgeries consisted of 541 (85.7%) liver resections (389 minor and 152 major). Radiofrequency ablation was performed in 61 (9.7%) cases and exploration in 29 (4.6%) cases. There were 138 (21.9%) redo procedures. A major morbidity (Clavien-Dindo grade ≥ 3a) was present in 84 (13.3%) cases. The 90-day mortality was 3.8%. In cases with a clinical risk score of 0, the median survival time was 69 months and 5- and 10-year overall survival was 57% and 38%, respectively. Conclusion: The complete surgical removal of metastases accompanied by favorable prognostic factors offers long-term survival in CLM patients.
colorectal cancer, liver metastases, hepatectomy, survival
Copyright (c) 2022 Irena Plahuta, Tomislav Magdalenić, Špela Turk, Stojan Potrč, Arpad Ivanecz https://creativecommons.org/licenses/by/4.0
Effects of differential time and difficulty weighting on the improvement of OSCE quality metrics
Purpose: Objective structured clinical examination (OSCE) has become a leading method for assessing clinical skills. A common problem observed in OSCE is the discrepancy between checklist scores and global scale scores. To reduce this discrepancy, checklists have been unsuccessfully weighted. However, differential weighting based on a combination of time and difficulty weighting had not been investigated. The goals of our study were to: (a) develop new formulas for time and difficulty weights, (b) design an experimental checklist considering the calculated weights, and (c) evaluate the effectiveness of the method in improving OSCE quality metrics. Methods: First, we created formulas for time and difficulty weights for each checklist item. Second, we formulated an experimental checklist considering the calculated weights of each item. Simultaneously, a control checklist was independently weighted by OSCE board members. Third, we compared the experimental and control checklists during the OSCE, wherein students (n=55) were graded by ten assessors using both checklists and the holistic global rating form. Finally, we performed statistical analysis with paired samples t-test, simple linear regression, and scale reliability statistics. Results: A higher correlation coefficient between the checklist and the holistic scoring form (r=0.622, p<0.001 vs. r=0.496, p<0.001), and significantly lower checklist scores (p<0.001), were obtained with the experimental checklist than the control checklist. Conclusion: Assigning time and difficulty differential weights to checklist items improved OSCE quality metrics and reduced the discrepancy between global and checklist scores.
OSCE, clinical skills, peer assessment, quality metrics, weighting, outliers
Copyright (c) 2022 Matic Mihevc, Klara Masnik, Tadej Petreski, Nejc Pulko, Sebastjan Bevc https://creativecommons.org/licenses/by/4.0
Clinical manifestaions of renal disease in patients with tuberous sclerosis complex at University Medical Centre Maribor
Purpose: Tuberous sclerosis is an autosomal dominant neurocutaneous syndrome that affects approximately 1/6000–10,000 people. The clinical presentation varies and is dependent on patient age. Renal manifestations, most often angiomyolipomas, cystic renal disease, and renal carcinoma, are present in 48%–80% of patients with tuberous sclerosis. The aim of our study was to determine the clinical characteristics and extent of renal impairment in patients with tuberous sclerosis who were followed at the University Medical Centre Maribor. Methods: We reviewed the medical records of patients with tuberous sclerosis (ICD Q85.1) who received care at the University Medical Centre Maribor. The medical history, clinical characteristics, laboratory results, imaging studies, and current treatment were highlighted. In addition, the results of genetic analysis were reviewed. Results: Our cohort consisted of 13 patients with tuberous sclerosis (age range, 7–71 years; median age, 16 years; average age, 25.2 [14.6-35.9] years). Cutaneous pathology was noted in 12 (92%) patients. Renal manifestations were present in 6 (60%) of the patients; 46% had angiomyolipomas and 23% had renal cysts. No significant renal function impairment was demonstrated. Two patients were treated with systemic everolimus and two patients were treated with topical everolimus for skin lesions. Genetic analysis was performed in seven patients, five of whom were positive and two of whom were negative. Conclusion: In agreement with literature reports, our results confirmed that renal impairment frequently occurs in tuberous sclerosis patients; however, because most of our patients were children, renal function was stable and treatment was rarely needed. Regular screening and follow-up evaluations in the multidisciplinary team are essential for good long-term outcomes.
tuberous sclerosis, kidney, angiomyolipomas, kidney cysts
Copyright (c) 2022 Sonja Golob Jančič, Peter Gradišnik, Andreja Osterc Koprivšek, Albin Gačnik, Nataša Marčun Varda https://creativecommons.org/licenses/by/4.0
Risk factors for surgical site infection following craniotomy: a 10-year retrospective cohort study
Purpose: A craniotomy is a common surgical procedure with complications, including a surgical site infection after craniotomy (SSI-CRAN), for which risk factors are ill-defined. Therefore, we determined the risk factors for developing an SSI-CRAN in adult patients at a university hospital in Maribor. Methods: A retrospective cohort study was conducted to compare patients with an SSI-CRAN (n=66) against a control group (n=70) from January 2009 to August 2019. We collected data from patients in who elective craniotomy had been performed and required surgical treatment for an infection. Results: A total of 1192 patients underwent a craniotomy, of whom 66 (5.5%) developed an SSI-CRAN. The most common infections were osteomyelitis (66.7%) and epidural abscesses (63.6%). The most frequent causative organism was Propionibacterium acnes (54.5%). Based on Fisher’s exact test, the factors associated with an SSI-CRAN compared to the control group were use of Surgicel® (89.4% vs. 67.1%, p=0.0019), use of dural substitutes (53% vs. 27.1%, p=0.0028), use of adhesive dura (13.9% vs. 2.9%, p=0.0274), sutures used for skin closure (69.7% vs. 34.3%, p=0.0001), a frontal craniotomy (28.8% vs. 12.9%, p=0.0328), and postoperative administration of glucocorticosteroids (73.7% vs. 54.4%, p=0.04). Conclusion: We identified risk factors associated with SSIs-CRAN, for which alternatives exist that could reduce the incidence of SSIs-CRAN.
craniotomy, risk factors, surgical site infection
Copyright (c) 2022 Hojka Rowbottom, Borut Hribernik, Janez Ravnik https://creativecommons.org/licenses/by/4.0
After completing our medical studies, we all swore to honor the Hippocratic Oath. To this day, the Hippocratic Oath is still sworn by new generations of young physicians. I am not sure if we are aware that the Hippocratic Oath is vital for all physicians because it defines and outlines our mission. The Hippocratic Oath constitutes our way of living, thinking, and acting, and thus deserves to be respected. Modern medicine, which is becoming increasingly dehumanized and profit-driven, must not mislead us. Not even when one of the most significant thoughts in the Hippocratic Oath – I will give no deadly medicine to anyone if asked, nor suggest any such counsel – might be dismissed due to a noble intention to help the dying. Do we understand what this oath demands, where it leads us to, how it guides us, and helps us make judgments when temptations in our daily lives may take us down a wrong path? Do we know how much truth lies in this oath, how much thought is still relevant today, and how many life orientations fulfill the mission of every single physician?
Copyright (c) 2022 Dušica Pahor https://creativecommons.org/licenses/by/4.0
Health-related quality of life in Slovenian pediatric and young adult patients with rare kidney diseases
Purpose: Patients with rare kidney diseases require specialized and typically lifelong treatments. Quality of life is an important aspect of a person’s well-being, and it is influenced by numerous factors. This cross-sectional study aimed to assess the quality of life of affected children and young adults to guide optimal treatment and enhance care. It is based on our research paper that was awarded the Dean’s Recognition for Students on December 6, 2024. Methods: The study included patients aged 2–25 years with rare kidney diseases who were managed in the Department of Pediatrics at the University Clinical Centre Maribor and registered in the European Rare Kidney Disease Registry. The Pediatric Quality of Life Inventory questionnaire was sent to the participants and their parents as proxy reports, and 69 patient questionnaires and 58 parent questionnaires were obtained for analysis. Descriptive methods were used to present the results. The Kruskal–Wallis and Dunn’s post hoc test with Bonferroni correction were used to determine functioning differences among different age groups, whereas the paired-samples t test was used to compare parent–child responses. Results: Patients rated their overall quality of life with a median of 82.5 [interquartile range (IQR) = 17.45], whereas parents rated it with a median of 83.91 (IQR = 17.85), out of 100. Adolescents had better social functioning than young children (H = 11.335; P = 0.023). Parents’ reports aligned with those of children [physical (t = –0.354; P = 0.725), emotional (t = –0.574; P = 0.569), social (t = 0.061; p = 0.951), school (t = –0.271; P = 0.787), and total functioning (t = –0.765; P = 0.448)]. Conclusion: Participants had good overall functioning, highlighting the importance of multidisciplinary care and the need for further interventions to enhance health and prevent potential deterioration.
Copyright (c) 2025 Nina Trstenjak, Nastja Zupanc, Nataša Marčun Varda (Author) https://creativecommons.org/licenses/by/4.0
Systemic food embolism in a case of atrio-esophageal fistula after alcohol ablation of the Marshall vein: A case report
Purpose: Ablation procedures are common and standard therapeutic interventions for symptomatic patients with persistent atrial fibrillation (AF). Various complications have been observed after the procedure, with one of the most fatal being atrio-esophageal fistula (AEF). Although rare, AEF has very high morality. Diagnosis of AEF is challenging, especially in emergency settings, because of its unspecific clinical signs, such as atypical neurological signs after food or air embolism. Case Presentation: A 46-year-old woman with a 10-year history of AF underwent ethanol infusion of the Marshall vein. Almost a month after the procedure, the patient collapsed and was brought to the emergency department with signs of right side hemiparesis. Occlusion of the left middle cerebral artery was identified with no ischemic change in brain parenchyma. During thrombectomy the patient had a sudden episode of hematemesis. After esophagogastroscopy, she was immediately transferred to the operating room for emergency surgery, but died on the operating table. Autopsy confirmed a clinical suspicion of AEF with massive gastrointestinal bleeding and systemic food embolism. We present this case to improve clinical recognition of the signs of AEF after alcohol ablation for AF. We also recommend active surveillance for patients who undergo similar procedures, including regular check-ups.
food embolism, atrio-esophageal fistula, alcohol ablation, case report, atrial fibrillation
Copyright (c) 2024 Živa Ledinek, Marko Hojnik (Author) https://creativecommons.org/licenses/by/4.0
Patient Blood Management: Where Are We Now and What Should We Do?
Patient blood management (PBM) is an interdisciplinary, patient-centred approach based on three pillars: 1) comprehensive anaemia management; 2) minimization of blood loss and optimization of coagulation perioperatively; and 3) leverage and optimization of patient-specific physiological tolerance of anaemia. The effectiveness and safety of PBM, together with the fact that >30% of the world population is anaemic with detrimental health and economic consequences, led the World Health Organisation to issue a policy brief in 2021 on the urgent need to implement PBM. Implementation of the PBM programme, differs among European countries. On the basis of the current guidelines, the Central Eastern European Patient Blood Management Steering Committee reached a consensus in 2024 to ensure minimal hospital standards of PBM implementation in Central and Eastern European countries. This article describes the PBM programme, its current status, and the possibilities for its perioperative implementation, according to the three pillars of PBM, at the University Medical Centre Maribor, as the second largest hospital in the Republic of Slovenia, from the point of view of an anaesthesiologist and a clinical pharmacologist. Its purpose is to inform readers about the importance of PBM implementation and raise awareness of the need for urgent action by healthcare providers and authorities to ensure optimal patient care.
preoperative anaemia, transfusion, blood loss, optimization of coagulation, iron deficiency
Copyright (c) 2024 Miodrag Žunić (Author) https://creativecommons.org/licenses/by/4.0
Chitosan nanoparticles as potential antimicrobial coating
Purpose: To evaluate the antimicrobial efficacy of chitosan nanoparticles in comparison to a chitosan solution, as well as to assess their practical application on medical textile materials. Methods: Dispersions of nanoparticles with different weight fractions of chitosan were prepared. An optimal chitosan nanoparticle system for textile material application was identified based on analyses of charge, particle size, changes in surface charge (zeta potential), concentration of free amine groups (polyelectrolyte titration), morphology, and antimicrobial properties. The effect of the nanoparticles dispersion application compared to the chitosan solution was determined using the ASTM E2149-01 antimicrobial test with Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria and a fungus (Candida albicans). Results: More effective application of chitosan was noted with the incorporation of chitosan nanoparticles. Applying chitosan on the inside and outside of the functional material enhanced the specific surface area and improved the accessibility of the chitosan coatings. Applying chitosan nanoparticles provided effective antimicrobial protection against all three microorganisms tested. Conclusions: Chitosan deposition in the form of nanoparticles compared in form of solution, offered better antimicrobial protection. Such functionalised material presents a promising application in medical textile materials.
chitosan, nanoparticles, antimicrobial activity, coatings, medical textile materials
Copyright (c) 2024 Zdenka Peršin Fratnik, Uroš Maver, Metod Kolar, Olivera Šauperl, Lidija Fras Zemljič, Boštjan Vihar (Author) https://creativecommons.org/licenses/by/4.0
Molecular tissue markers integrated: A mathematical model approach to evaluating and predicting prostate cancer using molecular tissue markers
Purpose: The standard criteria available for the diagnosis of prostate cancer often do not sufficiently predict the course or outcome of this common disease. Evaluating molecular tissue markers, especially those that mark apoptosis and proliferation, in an integrated mathematical model, could contribute to a better understanding of the development and pathogenesis of this disease, aid in the selection of adequate therapies, and open new avenues of therapeutic research. Materials and methods: Paraffin-embedded prostatectomy specimens were stained according to an immunohistochemical protocol for p53, bcl-2, and CD105. A mathematical model was developed, which incorporated values of tissue markers according to their apoptotic/proliferative characteristics. Results: The results of tissue marker expression and mathematical modeling were correlated with patient clinical data. We showed that tissue marker values correlated better with clinical data when tissue markers values were incorporated in a mathematical model than when applied alone.
mathematical model, prostate cancer, tissue marker, p53, bcl-2, CD105
Copyright (c) 2024 Mihael Munda (Author) https://creativecommons.org/licenses/by/4.0
Perception of patient-centered care in three fertility clinics: influence of domestic or cross-border treatment and reimbursement policy
Introduction: This study aimed to evaluate the experience of patients undergoing patient-centered care (PCC) at three fertility clinics in Southeastern Europe in terms of the treatment cost coverage and quality of care provided. Methods: Couples who underwent assisted reproductive technology (ART) were divided into three groups: (i) Slovenian patients covered under the national insurance programme; (ii) self-pay patients receiving treatment in their country of origin/a clinic abroad; and (iii) cross-border self-pay patients receiving treatment in Maribor, Slovenia. A standardized questionnaire, the “Patient Centeredness Questionnaire on Infertility Treatment (PCQ-Infertility)”, was translated into each patient’s native language and administered to 400 couples, of whom 78% completed it. For each of the three patient groups, the mean scores of the PCC domains and indicators were calculated. These data were then used for the score gap analysis. Results: Overall, the domain assessing the competence level of medical staff produced the biggest score domain gap (SDG) in the group of cross-border, self-pay patients, while the smallest score was observed for the health organization domain in the group of domestic patients with reimbursed cycles. In our research, the indicator corresponding to information about any possible side-effects of the prescribed medication produced the smallest score indicator gap (SIG), while the biggest SIG was observed for staff members assigned to be contacted for questions at any time. Conclusion: The results did not show that the financing method of ART treatment affected patient experiences of PCC. Although the competence of the medical staff is rated highly, domestic patients with reimbursed ART cycles continue to experience a lack of PCC in the health organization domain.
assisted reproductive therapy, cross-border patients, patient treatment experience, patient centeredness, quality of care
Copyright (c) 2024 Veljko Vlaisavljević, Borut Kovačič (Author) https://creativecommons.org/licenses/by/4.0
Subtotal petrosectomy in cochlear implantation
The main indication for subtotal petrosectomy (SP) in cochlear implant surgery is chronic otitis media with or without cholesteatoma. In addition to chronic otitis, other indications for surgery include inner ear malformations with the possibility of cerebrospinal fluid leakage and anatomical abnormalities. The main goal of the surgical technique is to eliminate the inflammation in the mastoid cavity and insert an electrode into the inner ear. Over the past thirteen years, the procedure has been performed in 15 patients with an average follow-up of 61 months. In all patients, complete insertion of the electrode was achieved, and the cavity was filled with abdominal fat. Revision surgery was required in three patients with preservation of the device. All patients are still using the cochlear implant. Subtotal petrosectomy is a safe procedure. However, follow-up is required for at least ten years after surgery. Meticulous surgery with removal of all disease, middle ear mucosa, and epithelium, the complete sealing of the external ear canal, and covering of the implant to prevent extrusion are critical for a successful surgical result.
subtotal petrosectomy, cochlear implantation, chronic otitis, deafness, inner ear malformations
Copyright (c) 2024 Janez Rebol (Author) https://creativecommons.org/licenses/by/4.0
Pancreas transplantation: indications, surgical technique, and clinical significance
Pancreas transplantation (PT) is a vital therapeutic option for patients with diabetes mellitus (DM)|, particularly those with end-stage renal disease (ESRD) or severe metabolic complications. Over the past several decades, advancements in surgical techniques, organ preservation and procurement methods, and immunosuppression therapies have significantly enhanced post-transplant patient survival, graft survival, and quality of life. The primary goals of PT are to achieve effective and stable glycemic control, often leading to insulin independence, improve the patient's quality of life, and reduce secondary complications associated with DM. PT encompasses a variety of procedures, including PT alone from a living donor, whole PT, pancreas with kidney transplantation, and pancreatic islet cell transplantation. PT is most commonly performed in conjunction with kidney transplantation for selected patients with DM and ESRD. Over the past decade, unadjusted patient survival rates have exceeded 96% at 1-year post-transplant and > 80% at 5 years.
pancreas transplantation, diabetes mellitus, glycemic control, simultaneous pancreas-kidney transplantation
Copyright (c) 2024 Gaja Hladnik, Vojko Flis (Author) https://creativecommons.org/licenses/by/4.0
A narrative review of ADME testing platforms
Background: Significant progress has been made in absorption, distribution, metabolism, excretion (ADME) models, but the creation of platforms that reduce animal testing and research costs is still challenging. The increasing complexity of pharmacokinetic interactions underscores the need for reliable, reproducible ADME models, which are essential for drug development and safety to prevent serious clinical complications and hospitalizations. Aims: This narrative review aimed to discuss multi-organ, function-based ADME platforms and evaluate recent developments in microphysiological systems (MPS) emphasizing functional accuracy. Methods: We evaluated MPS models developed to improve the relevance of in vitro drug interaction studies by emphasizing critical tissue function over detailed anatomical mimicry. We also highlighted the strengths and limitations of these platforms in replicating the full complexity and functionality of native tissues. Results: Despite making progress in structural replication, MPS models often lack the functional fidelity required for accurate drug testing. Models that emphasize functionality rather than complex structural details show promise in producing results relevant to humans, thus providing an alternative to animal testing. Conclusions: A shift in focus from anatomical complexity to mimicking key tissue functions is required to fully realize the potential of MPS in ADME studies. Addressing the current limitations of biomedical engineering in this way may support the ethical, scientific, and regulatory goals of preclinical research. MPS can bridge the gap between traditional models and human-relevant systems by emphasizing functional accuracy, thus increasing the translational value of ADME studies and contributing to effective, ethical drug discovery.
pharmacokinetics, ADME, in vitro models, drug interaction studies, multi-organ models
Copyright (c) 2024 Tina Maver, Boštjan Vihar, Uroš Maver (Author) https://creativecommons.org/licenses/by/4.0
We cannot wish for success, and we cannot seek it. Success is not the goal. It is the result of our work.
The Day of the University of Maribor, September 12, 2024 - Upon the presentation of this year's awards and acknowledgments on the Day of the University of Maribor, I was given the pleasant opportunity to show my gratitude on behalf of all award winners. Among this year's recipients was Sir Gregory Paul Winter, who won the Nobel Prize in chemistry in 2018, and who on that auspicious day was awarded an honorary doctorate by the university ...
Copyright (c) 2024 Dušica Pahor (Author) https://creativecommons.org/licenses/by/4.0
Severe Varicella-Zoster virus pneumonia in a healthy young adult treated with acyclovir and extracorporeal membrane oxygenation: a case report
Purpose: Varicella-zoster virus (VZV) infection is common in children and is usually benign. In adults VZV infection can present as a severe primary viral pneumonia with acute respiratory failure. VZV infections in adult have a high mortality rate. Case report: A 32-year-old previously healthy male first presented to the emergency department with flulike symptoms and no rash. Three days later he returned to the emergency department with a disseminated skin rash and severe acute respiratory distress syndrome that required intubation and mechanical ventilation. A VZV infection was confirmed. Mechanical ventilation was insufficient and venovenous extracorporeal membrane oxygenation was introduced. In addition to supportive measures, he was treated with intravenous acyclovir. During hospitalisation he developed several complications, including severe cor pulmonale necessitating treatment with nitrous oxide and milrinone, disseminated intravascular coagulation necessitating an extracorporeal membrane change, and ventilator-associated pneumonia. He was discharged home in stable condition on hospital day 27. Conclusion: Primary VZV infection in adulthood is associated with several complications. Early recognition of acute respiratory failure, ventilatory support, and early administration of acyclovir are crucial elements of VZV pneumonia treatment.
Copyright (c) 2024 Luka Varda, Metin Omerović, Barbara Kit, Franc Svenšek, Jure Fluher, Iva Cestar, Martin Marinšek, Andrej Markota (Author) https://creativecommons.org/licenses/by/4.0
Ventricular arrhythmias and cardiac arrest in aconitine poisoning: a case report
In traditional Chinese medicine, aconitum plants and roots are frequently used after extensive processing to treat various ailments in humans. However, use of a larger than recommended dose and inadequate processing increase the risk of aconitine poisoning. As a result of its particular mechanism of toxicity, aconitine poisoning can present with a variety of arrhythmias, including ventricular ectopy, ventricular tachycardia, ventricular fibrillation, and torsades de pointes. Meticulous arrythmia treatment is needed to restore sinus rhythm. We report a case of ventricular arrhythmias (VAs) induced by accidental aconitine poisoning. Our case highlights the efficacy of amiodarone in treating aconitine-induced VAs. To the best of our knowledge, this is one of the first described cases of aconitine-induced VAs in Europe. Clinicians should be aware of potential rare toxicological causes of malignant arrhythmias and consider toxicological screening in otherwise etiologically unexplained sudden cardiac arrest.
Copyright (c) 2024 Nino Cmor, Gašper Razinger, Jure Fluher, Andrej Markota (Author) https://creativecommons.org/licenses/by/4.0
Acute pancreatitis in a patient with normal lipase: a case report
This case report highlights the rare occurrence of acute pancreatitis in a patient exhibiting normal lipase levels. The patient presented to the emergency department with abdominal pain and fever. Laboratory tests indicated an acute inflammatory process but a negative lipase value. The diagnosis was established by a CT scan showing necrotizing pancreatic changes with elevated carbohydrate-deficient transferrin (CDT) levels, suggesting alcohol as the etiology. Management involved supportive care, aggressive fluid resuscitation, nutritional support, and empirical antibiotic therapy, which led to clinical improvement. This case emphasizes the importance of a comprehensive clinical assessment beyond standard biochemical markers in diagnosing and managing pancreatitis.
Copyright (c) 2024 Tjaša Kitanovski, Andrej Grahek, Žan Garvas (Author) https://creativecommons.org/licenses/by/4.0
Hybrid fixation for repair of dual forearm fractures of adolescent patients: A case report and literature review
Purpose: To assess hybrid fixation as an alternative option for repair of dual forearm fractures of adolescent patients. Case presentation: An 11-year-old boy presented with trauma to his right forearm resulting from playing on a trampoline. X-ray examinations confirmed fractures of both the right ulna and radius. Closed reduction and internal ESIN (elastic stable intramedullary nailing) fixation was selected for repair of the radius. Closed reduction of the ulnar fracture was unsuccessful, thus open reduction was performed. However, due to instability of the ulnar fracture after open reduction, internal plate fixation of the ulna was selected. At 3 months after surgery, the patient demonstrated full range of motion with no pain.
elastic stable intramedullary nailing (ESIN)
Copyright (c) 2024 Igor Movrin (Author) https://creativecommons.org/licenses/by/4.0
Patient Satisfaction with Electronic Sick Leave Certificates: Survey of Family Medicine Outpatient Clinics
Purpose: In Slovenia, the transition from paper-based to electronic sick leave certificates (hereafter referred to as eBOLs) started at the beginning of 2020. While paper sick leave certificates are still widely used worldwide, many European countries are already reaping the benefits of using the eBOL system. This survey aimed to determine patients' satisfaction with the new eBOLs and highlight the most significant advantages and disadvantages from the patient's viewpoint. Methods: A quantitative cross-sectional survey was conducted in Maribor, Slovenia, and the surrounding area to collect quantitative data from family medicine outpatient clinics. Two hundred and fifty patients were randomly selected among those receiving either paper or electronic sick leave certificates. The survey was conducted online with a web survey link and consisted of two parts. The first part included eight items measuring patients’ experiences with electronic and paper sick leave certificates, rated on a five-point Likert scale. The second part consisted of two multiple-choice questions regarding the advantages and disadvantages of eBOLs. The data were analysed using bivariate statistical analysis. Results: Out of the 250 patients invited to participate in the study, 80 responded, resulting in a response rate of 32%. The mean age of the participants was 46.2 ± 11.2 years, with 56 (70%) women and 24 (30%) men. After more than a year of usage, 57 (71.3%) respondents expressed complete agreement that the eBOL system makes it easier for patients to manage their sick leave. Furthermore, 55 (68.8%) participants considered eBOLs as a good alternative to paper sick leave certificates. Most participants (76 (95%)) considered avoiding additional outpatient visits to manage their sick leave as the most significant advantage of using eBOLs. However, 64 (80%) respondents expressed uncertainty about the data sent by the eBOL system as the most significant disadvantage. Summary: The survey results showed that patients were already significantly satisfied with the eBOL system when it was first introduced and that their satisfaction increased with continued use. A broader survey including a larger number of Slovenian outpatient clinics and capturing both patients' and doctors' opinions would provide more precise and broader insights into the newly introduced IT system's advantages and disadvantages and its users' satisfaction.
Copyright (c) 2024 Ksenija Tušek Bunc, Primož Bobek (Author) https://creativecommons.org/licenses/by/4.0