Acute pulmonary embolism (PE) management guidelines categorize normotensive patients with right ventricle dysfunction (RVD) and normal cardiac troponin (cTn) as intermediate low risk. This study explores the prevalence of cardiovascular comorbidities and their impact on risk stratification in this specific cohort. To investigate the characteristics of normotensive acute PE patients with RVD and normal cTn, emphasizing the role of pre-existing cardiovascular diseases in determining the intermediate-low risk status. A total of 1675 PE patients from a regional registry were screened, excluding high-risk and intermediate-high-risk cases. Among the remaining 400 normotensive patients with RVD, 353 with echocardiography and normal cTn were included. Patients were categorized into low or intermediate-low risk based on RVD presence. Cardiovascular comorbidities were assessed, and logistic regression analyzed their association with intermediate-low risk. Intermediate-low-risk patients (n=137) exhibited significantly higher rates of chronic heart failure, arterial hypertension, coronary artery disease, diabetes, and atrial fibrillation compared to low-risk patients (n=216). A substantial 77.4% of intermediate-low-risk patients had at least one cardiovascular comorbidity, significantly elevating the risk of RV dysfunction (adjusted OR 2.954, p<0.001). The all-cause hospital mortality was 5.1% in intermediate-low-risk and 1.4% in low-risk PE. Normotensive acute PE patients with RVD and normal cTn are predominantly burdened with chronic cardiovascular conditions. The majority of intermediate-low-risk patients have at least one cardiovascular comorbidity, indicating an increased risk of death during hospitalization compared to low-risk patients. This study underscores the necessity for nuanced risk stratification considering pre-existing cardiovascular diseases for tailored and effective management. These findings have important implications for optimizing treatment strategies and improving outcomes in this high-risk population.

Active malignant disease is associated with pulmonary embolism and the treatment of this condition is very challenging. The efficacy and safety of thrombolytic therapy for acute severe PE in patients with active malignant disease is unknown. This study aimed to investigate hospital mortality rate and the incidence of major bleeding at 7 days according to the International Society of Thrombosis and Hemostasis (ISTH) criteria in patients with active malignant disease who were treated with thrombolytic therapy due to severe acute PE. Patients with acute PE proven by computed tomography pulmonary angiography who were admitted to intensive care units have enrolled in the Regional PE Registry (REPER) since 2015, consisting of 10 hospitals from the 4 east Balkan countries. The decision to use thrombolytic therapy was at the discretion of the attending physicians, and it was used in high-risk, and intermediate-high-risk PE patients. Hospital mortality and the incidence of major bleeding at 7 days were compared between patients with active cancer and those without it who received thrombolytic therapy. Alteplase-based therapy was used. Among 2070 patients with acute PE enrolled in REPER, intermediate-high and high-risk PE had 795 patients without malignant disease and 135 had active malignant disease in the last 6 months. Patients with malignant disease had less chance to be treated with thrombolysis than patients without it (29.1% vs 44.7%, OR 0.508, 95%CI 0.341-0.756, p=0.001). For patients treated with thrombolysis, hospital mortality was non significantly higher in patients with the malignant disease compared to patients without it (25.6% vs 16,1%, OR 1.803, 95%CI 0.833-3.904, p=0.132), and the incidence of major bleeding at seven days was similar (15.4% vs 18.5%, OR 0.800, 95%CI 0.322-1.989, p=0.6131). There was no significant difference in age, sex, and PE risk distribution between patients with active malignant disease and those without it who were treated with thrombolysis. Thrombolytic therapy seems to be underutilized in patients with the active malignant disease compared to patients without it in severe acute PE. In the selected patients who were treated with thrombolysis for severe acute PE, the efficacy and safety are similar between patients with and without active malignant disease.

Background/Objectives: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a widely employed self-report tool for assessing upper extremity function. The aim of this study was to assess the psychometric properties of the Serbian version of the DASH by determining its criterion and construct validity, as well as internal consistency. Methods: This cross-sectional study was conducted among patients with hand and wrist disabilities at the Institute for Orthopedics “Banjica”, Serbia. The psychometric properties of the Serbian version of the DASH were analyzed through an examination of its factorial structure and internal consistency. The DASH consists of 30 items, 24 of which assess function, 21 of which focus on physical function and three on social/role function. The remaining six items evaluate symptoms related to pain, tingling/numbness, weakness, and stiffness. Results: A total of 297 patients were included in the study. The mean age was 47.4 ± 16.8 years, with 50.5% males. Three models were assessed to determine the reliability and validity of the questionnaire across different domains. Model 1 examined a single-factor structure. In Model 2, the items were divided into two domains: Physical Function and Psychosocial/Symptoms. In Model 3, items were subdivided into three domains: Physical Function, Symptoms, and Psychosocial. All models demonstrated an excellent internal consistency with a Cronbach’s alpha > 0.9 for most domains. The values for the fit indices Tucker–Lewis index (TLI) and Comparative-Fit Index (CFI) were above their cut-off criteria of 0.9, while the Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) were below the suggested value of 0.06, indicating an excellent level of models fit. Standardized factor loadings were statistically significant (p < 0.05). Conclusions: The present study provided the evidence for the appropriate metric properties of the Serbian version of the DASH. Results support both the unidimensional and multidimensional structures of the DASH.

Objectives Medical adhesives provide securement of medical devices, facilitate skin protection and allow non-invasive monitoring. Application and removal of medical adhesives can result in pain, dermatitis, trauma or other skin lesions. Understanding patients’ experiences when subjected to medical adhesives will contribute to the improvement of clinical routines and the development and improvement of new adhesive technologies. A qualitative systematic review was conducted to identify patients’ experiences with the application of medical adhesives to the skin. Design Qualitative systematic review. Data sources CINAHL, EMBASE, MEDLINE and PsycINFO were systematically searched for records published between January 2012 and March 2024. Reference lists of systematic reviews and included articles were reviewed. Eligibility criteria Studies published in Danish, Dutch, English, German, Norwegian and Swedish that collected qualitative data on the experience of patients with the application of medical adhesives to the skin were considered. There were no restrictions regarding age, gender or setting. Data extraction and synthesis Study selection, data extraction and quality appraisal were independently conducted by two reviewers. The methodological quality of the studies under consideration was assessed using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Research. The extracted data were synthesised using meta-aggregation. Results Nine studies describing patients’ experiences were included. The included studies only reflected experiences with wound dressings. Meta-aggregation of the extracted findings resulted in seven categories that were further synthesised into two synthesised findings: ‘strategies to alleviate pain during dressing changes’ and ‘dressing construction and characteristics’. The synthesised findings illustrate that patients experience pain during dressing change and removal and employ various strategies to alleviate this pain. Conclusions Patients experience pain and discomfort when dressings are changed or removed. Future research should focus on enhancing both routines and technologies, with a particular emphasis on advancing skin-friendly adhesives to reduce unwanted side effects. PROSPERO registration number CRD42023457711.

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Čitajući hroniku Idrīsa Bidlīsija na mnogim mjestima nalazimo zapise o aktivnostima špijuna kao o ele- mentu ratne strategije Osman- ske države, bilo kroz direktne ili indirektne reference. Ovaj čla- nak filološkim metodama istražuje zapise o obavještajnim aktivnosti- ma Osmanske države u imperijal- noj ekspanziji, koje nalazimo u di- nastijskoj hronici Idrīsa Bidlīsīja i njegovim izvještajima iz misije os- mansko-safavidskog sukoba. Di- nastijska hronika datirana do prve decenije 1500-tih, iako sa šturim podacima, vrijedan je historijski iz- vor koji daje sliku rada i doprinosa špijunskih mreža u vojnopolitičkoj strategiji osmanske imperijalne politike. Bidlīsījeva pisma kao izvještaji komplementarni su izvori Bidlīsījevoj hronici. Osmansko carstvo, osmanska vojna historija, obavještajne aktivnosti, hronika Hešt bihešt, pisma Idrīsa Bidlīsīja

With the emergence of new sensor technologies, such as fiber optic sensors (FOSs), compared to traditional mechanical sensors, unobtrusive sleep monitoring has been a research focus for decades. This work aims to provide a guide to current bed-based sensor technologies with diverse applications in various settings. We conducted a retrospective literature review, summarizing the state-of-the-art research over the past decade on non-contact bed-based sensor technology in sleep monitoring. We developed a three-category terminology: unobtrusive sensor technology, application, and subject. A total of 263 unique articles were acquired from three databases and screened for relevance, resulting in 21 papers selected for in-depth analysis. The findings revealed eight types of sensors: six mechanical sensors (pressure, accelerometer, piezoelectric, load cell, electromechanical film (EMFI), and hydraulic) and two FOSs (fiber Bragg grating and microbend FOS) that are integrated with or positioned under the bed at three levels of unobtrusiveness. We identified 15 parameters, with heart rate (HR) (14) and respiratory rate (RR) (13) being the most frequently measured. These parameters are generally categorized into three applications: disease-related diagnosis (18), general sleep analysis (9), and general well-being (11). The results indicated that sleep apnea (5) and insomnia (2) were the most frequently detected sleep disorders. Additionally, 59.1% (13) of the systems were tested in a lab environment, with only one undergoing clinical trials. In summary, there is a clear lack of convincing proof of the systems’ effectiveness in continuous in-home sleep monitoring.