Multiple sclerosis (MS) is a chronic demyelinating neurological disorder predominantly affecting young adults. Based on the data of the MS Atlas 2020, there are 2.8 million people living with MS worldwide. 1 Investigation of the comorbidity burden in persons with MS (PwMS) has become increasingly important since studies have shown that co-occurring conditions may have negative effects on health outcomes in PwMS. 2-4 Among different comorbidity groups, cardiovascular diseases (CVD) are of particular interest because of their high prevalence in the general population, high rank among

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This article focuses on the social dimension of well-being, based on a critical analysis of the way it is conceptualised in late capitalism: As the dimensions of individual state of mind and body, something that evolves in the individual realm, stressing personal responsibility and achievement of well-being as a solitary act. Then, the contemporary conceptualisation and approaches to policy making for well-being are compared with the policy of adult and youth education and learning. The perspective of a strong individual orientation, detachment from the social, community and collective aspects and efforts seem to be a common denominator. Agency is considered not only as a possibility for individuals to create and change the environment, but also as a process of active co-construction of social reality. This includes (re)connection with a community, very often through new ways of community learning, civic actions and civic activities. An analysis of how these perspectives converge in civic interventions in urban areas of Belgrade places togetherness at the core of the broader approach to well-being and learning. This article presents several examples of civic activities in urban spaces whose learning character is interpreted within the concept of

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FIBRIN GLUE MESH FIXATION UNDER LOCAL ANAESTHESIA FOR THE TREATMENT OF INGUINAL HERNIA IN ELDERLY PATIENTS R LionettF, A Cesaro 1 , E NapolitanoI, L Caruso 1 , B Neola1, M Rutigliano1, 0 P Ferulano1 iDpt. Specialistic Surgeries and Nephrology Policlinic Federico II, Naples, ITALY \ud Introduction: Inguinal hernia repair is one of the most common operations performed in general surgery, especially among elderly patients, due to age-related loss of muscle mass and increase of co-morbidities associated with high intra-abdominal pressure. The purpose of our trial was to assess the safeness and the impact on quality of life of tension free, sutureless hernia repair technique with the use of fibrin glue under local anesthesia in elderly patients. Methods: From January 2010 to December 2012,53 male patients aged 70 and above (mean age 73.9 years) were enrolled; complicated, recurrent, scrotal hernia and ASA IV patients were excluded. Furthermore diabetic patients with glycated hemoglobin level 7% or more were ruled out for presumable neuropathy. Informed consent and data from SF36 questionnaire were collected preoperatively. The Visual Analogue Scale (VAS) for postoperative pain and a new SF36 questionnaire for overall satisfaction at one year, were administered postoperatively. Chronic pain was classified according to Cunningham's criteria. Operative time, length of hospitalization, postoperative use of nonsteroidal anti-inflammatory drugs, complications and recurrences were also assessed. Results: All patients were operated under local anaesthesia (2% Mepivacaine Cloridrate and 7,5mg!ml Ropivacaine) with light sedation; in all cases partially absorbable mesh and plug (polypropylene! polyglecaprone 25) have been implanted and fixed with I ml of fibrin glue. 50 out of 53 patients completed the 2 years follow-up, one died for not related comorbidity. Mean operative time was 54.8 minutes; 46 patients were discharged at home the same day, 5 the following day, 2 patients had to stay one more day for postoperative complications (I haematoma, I urinary retention), no major complications were observed; at two years follow-up, 2 recurrences (4%) have been observed; mean VAS score for post-operative pain, assessed at 6, 12, 24 hours and 7 days after surgery, was 4 or less for 50 (94,3%) patients, only 3 (5,6%) patients referred a score> 4. At one year follow up only 2 (4%) patients suffered of chronic postoperative pain (I mild and I moderate), no severe chronic postoperative pain has been reported. Data from pre and postoperative SF36 questionnaires, analysed by using the Student's t test, showed significant increase of the score both in the Physical Component Summery (PCM) and in the Mental Component Summary (MCS) with a p-value < 0.0001. Conclusion: Inguinal hernia repair with use of fibrin glue and partially absorbable prosthesis under local anaesthesia is a safe technique in elderly patient

Introduction The aim of this systematic review and network meta‐analysis was to compare the short‐term results of fenestrated endovascular repair (FEVAR), chimney endovascular repair (ChEVAR), and open surgery (OS) for patients with juxta/pararenal abdominal aortic aneurysms (JAAA/PAAA). Materials and methods MEDLINE, SCOPUS, and Web of Science were searched from inception to 1 July 2022. Any comparative studies investigating the results of two or three treatment strategies (ChEVAR, FEVAR, or OS) on clinical outcomes for patients with JAAA/PAAA were included. Analysed outcomes were 30‐day mortality, acute kidney injury (AKI), major adverse cardiovascular events (MACE), and bowel ischaemia (BI). Results A total of 22 studies with 8853 patients were included in the analysis. FEVAR (OR = 0.58, 95%CrI 0.36–0.82) and ChEVAR (OR = 0.56, 95%CrI 0.28–1.02) were associated with lower 30‐day mortality than OS. FEVAR (OR = 0.54, 95%CrI 0.33–0.85) was associated with lower risk of AKI than OS. FEVAR (OR = 0.43, 95%CrI 0.20–0.89) and ChEVAR (OR = 0.34, 95%CrI 0.10–0.93) compared to OS were associated with lower rates of BI. FEVAR (OR = 0.67, 95%CrI 0.49–0.90) and ChEVAR (OR = 0.61, 95%CrI 0.35–1.02) were associated with lower 30‐day MACE risk than OS. FEVAR was associated with a higher rate of SCI compared to OS (OR = 4.90, 95%CrI 1.55–19.17). Conclusion We found a clear benefit for FEVAR and ChEVAR versus OS in terms of reduced 30‐day mortality, BI, and MACE, as well as AKI for FEVAR. This suggests that higher‐risk patients might benefit from endovascular treatment of JAAA/PAAA; however, should be applied in clinical practice with caution, since long‐term outcomes were outside of the scope of this review.

Background / Aim. The aim of this study was to evaluate the final-year medical students` competencies related to immunization challenges in their practice using the knowledge, attitudes, and practices study. Methods. The cross-sectional study was conducted among 442 final-year students of the Faculty of Medicine, University of Belgrade. The instrument used for data collection was an anonymous questionnaire consisting of 38 questions. Hierarchical multiple regression analysis was conducted to identify the predictive value of different factors in immunization knowledge among medical students. Results. The median total knowledge score with the interquartile range was 7 ? 3.00 out of the 13. There was a statistically significant positive correlation between the knowledge score and the grade point average (GPA) (?=0.207, p<0.001). Thirty-five percent of students feel moderately capable of conducting work regarding vaccination without supervision. Also, 92.1% of students consider that additional training and information channels about immunization need to be implemented in curricula for HCWs. The results of the hierarchical regression analysis showed that gender, age, GPA, study duration, self-confidence regarding immunization knowledge, flu and hepatitis B vaccination status explained a total of 36% of the variance in the immunization knowledge score. Conclusion. The results of our study showed an average level of knowledge about immunization among final-year medical students. However, less than two-thirds of students believe that they have enough knowledge to reassure a person who is hesitant about immunization. This underlines a need for a better understanding and improving the parts of the curricula of medical faculties regarding immunization.