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Cardiopulmonary Resuscitation, Chest Compression only and Teamwork from the Perspective of Medical Doctors, Surgeons and Anesthesiologists
No full textBACKGROUND: New resuscitation guidelines that were proposed by the European Resuscitation Council in 2010 have introduced a new method of cardiopulmonary resuscitation (CPR) by chest compressions only for untrained individuals.
OBJECTIVES: We conducted this study to evaluate differences in attitudes towards CPR among medical doctors, surgeons and anesthesiologists in Osijek University Hospital. A call for help, chest-compression-only resuscitation, mouth-to-mouth ventilation and team-work were recognized as critical points that may influence the outcome. Unfamiliarity with these methods may be indicative of a lack of education in resuscitation and may result in poor outcomes for victims.
PATIENTS AND METHODS: An anonymous survey was conducted on 190 medical professionals: 93 medical doctors, 70 surgeons, and 27 anesthesiologists during year 2012 (mean age 41.9 years). The questions were related to previous education in resuscitation, current resuscitation practices and attitudes towards cardiopulmonary resuscitation. Data were analyzed using ANOVA and Fisher exact test. A P value of < 0.05 was considered statistically significant.
RESULTS: The only difference between groups was regarding the male and female ratio, with more male surgeons (45, 55, and 11, P < 0.001). All doctors considered CPR as important, but only anesthesiologists knew how often guidelines in CPR change. Approximately 45% of medical doctors, 48% of surgeons and 77% of anesthesiologists reported that they have renewed their knowledge in CPR within the last five years, whereas 34%, 25% and 22% had never renewed their knowledge in the CPR (P = 0.01 between surgeons anesthesiologists). Furthermore, chest-compression-only was recognized as a valuable CPR technique by 25.8% of medical doctors, 14.3% of surgeons and 59.3% of anesthesiologists (P < 0.001). Anesthesiologists estimated a high risk of infection transmission (62%) and were more likely to refuse mouth-to-mouth ventilation when compared to surgeons (25% vs.10%, P = 0.01). Anesthesiologists are most often called for help by their colleagues, only rarely surgeons call their departmental colleagues and nurses to help in CPR.
CONCLUSIONS: An insufficient formal education in CPR was registered for all groups, reflecting the lack of familiarity with new CPR methods. A team education, involving doctors and nurses may improve familiarity with CPR and patient outcomes
Arterial Pressure and Heart rate Changes in Patients During “Beach Chair Position” for Shoulder Surgery: Comparison of the Regional and General Anesthesia Techniques
No full textBackground and Purpose: Patients scheduled to shoulder surgery are placed in a sitting position called “the beach chair position” during the operation. This type of surgery can be performed with two anesthetic techniques: general anesthesia or regional anesthesia (interscalene block). This patient positioning is characterized by changes in heart rate and systemic blood pressure. The aim of this study is to show whether the type of anesthetic technique influence the changes in systemic pressure and heart rate in this particular patient position.
Materials and methods: Retrospective clinical study with reviewed anesthetic charts and medical documentation of the patients scheduled for elective shoulder surgery. Point measurements of systolic and diastolic blood pressure and heart rate were: before surgery, after the positioning of the anesthetized patient, at the end of the operation (lodging of the patient) and then the lowest recorded pressure and heart rate during surgery.
Results: The study included 66 patients in the sitting position for shoulder surgery. Positioning the patients in the beach chair position for shoulder surgery in a population of patients undergoing general anesthesia in relation to the population of patients treated under regional anesthesia, had a significant effect on the decline in systolic blood pressure (p<0.001) and dyastolic blood pressure (p=0.008).
Conclusion: Regional anesthesia has proven again to be the superior technique over general anesthesia, including cardiovascular stability in patients subjected to shoulder surgery in the beach chair position
Klirens kreatinina i formule za računanje EGFR - Mogu li se koristiti naizmjenično?
No full textStudy goal was to examine which of glomerular rate equations is most suitable for prediction of creatinine clearance. Using a retrospective review of data from 500 hospital patients we calculated glomerular filtration rate according to Cockcroft-Gault equation (C-G), Modification of Diet in Renal Disease Study equation (MDRD) and Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). We determined if results of these equations were compatible with creatinine clearance, and does stage of kidney disease, body-mass index (BMI), diabetes or old age have an impact on their ability to predict creatinine clearance. All of the equations showed high correlations with creatinine clearance, regardless of diabetes, overweight or old age. There was no statistical difference (p65 years) and diabetics. The percentage of overweight subjects (BMI>25) in false positives (subjects with normal creatinine clearance and decreased GFR) was 64.8% for C-G, 88.6% for MDRD and 88.9% for CKD-EPI. Large number of overweight subjects with normal creatinine clearance and decreased GFR would indicate that creatinine clearance overestimates GFR in overweight subjects. Passing-Bablok regression showed agreement between creatinine clearance and MDRD and creatinine clearance and CKD-EPI only in cases of severely decreased GFR (G4 and G5 stage of chronic kidney disease). Only in these stages of chronic kidney disease can creatinine clearance and MDRD or creatinine clearance and CKD-EPI be used simultaneously.Cilj studije bio je ispitati koja od formula za izračun stope glomerularne filtracije (eGFR, engl. estimated glomerulal filtration rate) je najkorisnija za predviđanje klirensa kreatinina. Koristeći retrospektivni pregled podataka za 500 bolničkih pacijenata izračunali smo stopu glomerularne filtracije prema formulama Cockcroft-Gault (C-G), Modification of Diet in Renal Disease Study equation (MDRD) i Chronic Kidney Disease Epidemiology Collaboration equation (CKD- EPI). Ispitali smo koliko su rezultati ovih triju formula usporedivi s klirensom kreatinina, te da li stadij bubrežne bolesti, indeks tjelesne mase (BMI, engl. body-mass index), dijabetes ili starija dob utječu na njihovu sposobnost predviđanja klirensa kreatinina. Sve ove formule su pokazale visoku korelaciju s klirensom kreatinina, neovisno o di- jabetesu, prekomjernoj tjelesnoj težini ili starijoj dobi. Nije postojala statistička razlika (p25) u skupini lažno pozitivnih subjekata (onih s normalnim klirensom kreatinina i sniženim eGFR) bio je 64,8% za C-G, 88,6% za MDRD i 88,9% za CKD-EPI. Velik broj sub- jekata s povećanom tjelesnom težinom i normalnim klirensom kreatinina imao je snižen eGFR, što upućuje na to da klirens kreatinina precjenjuje GFR u subjekata s povećanom tjelesnom težinom. Passing-Bablok regresija je pokazala slaganje između klirensa kreatinina i MDRD, te klirensa kreatinina i CKD-EPI samo u slučajevima ozbiljnije sniženog GFR (G4 i G5 stadij kronične bubrežne bolesti). Samo u ovim stadijima kronične bubrežne bolesti klirens kreatinina i MDRD, te klirens kreatinina i CKD-EPI, se mogu koristiti simultano
Teške epileptične encefalopatije u dječjoj dobi: Sindromi West i Lennox – Gastaut
No full textEpileptic encephalopathies are epilepsy syndromes in which the epileptiform abnormalities themselves are believed to contribute to a progressive disturbance in cerebral function. The two most important syndromes in this group are West and Lennox–Gastaut syndromes. West syndrome frequently occurs in the fi rst year of life, in clusters with consequences such as developmental arrest and mental retardation. It characteristically presents with the triad of infantile epileptic spasms, developmental delay and hypsarrhytmia. The treatment is ACTH, prednisolone or valproate. Lennox–Gastaut syndrome typically presents with multiple seizure types, slow spike–wave complexes in the EEG and impaired cognitive function. It is treated with felbamate, lamotrigine, topiramate and rufi namide with poor response to treatment.Epileptične su encefalopatije epileptični sindromi kod kojih se vjeruje da su same epileptiformne abnormalnosti čimbenik
nastanka progresivnih poteškoća u cerebralnoj funkciji. Dva najznačajnija sindroma u ovoj skupini su sindromi West i Lennox–
Gastaut. Westov sindrom se učestalo pojavljuje u prvoj godini života s posljedicama kao što su zastoj u razvoju i mentalna retardacija. Trijas karakterističan za ovaj sindrom čine infantilni epileptični spazmi, zastoj u razvoju i hipsaritmija. Uobičajeno se liječi s ACTH, prednizolonom ili valproatom. Za Lennox-Gastautov su sindrom tipični različiti oblici konvulzija, spori šiljak-val kompleksi u EEG-u i oštećena kognitivna funkcija. Liječi se felbamatom, lamotriginom, topiramatom i rufi namidom uz slab odgovor na liječenje
Polymorphisms of Toll-like Receptors 2 and 4 in Chronically Infected Hepatitis C Patients from North-east Croatia
No full textChronic infection with hepatitis C virus (HCV) is caused by an inadequate immune response. Experimental data suggest that the impaired activation of Toll-like receptors (TLRs) 2 and 4 contributes to chronic infection. We assessed the distribution of three single-nucleotide polymorphisms (SNPs) in the TLR2 (Arg753Gln) and TLR4 (Asp299Gly/Thr399Ile) genes in individuals from north-east Croatia and their effect on the outcome of antiviral therapy. The study consisted of 60 chronically infected patients and 40 healthy subjects. TLR polymorphisms were determined by the PCR-based melting curve analysis. HCV genotyping was performed using the Linear Array Hepatitis C Virus Genotyping Test. Thirty-three patients were treated with standard interferon and ribavirin therapy, and their viral load was evaluated at weeks 28 and 53 after the beginning of therapy. The majority of chronic infections were caused by genotype 1 (77%), followed by genotypes 3 (15%) and 4 (7%). Patients with genotype 1 had higher viral loads than patients infected with other genotypes (P = 0.0428). Healthy individuals and patients with chronic infection had similar frequencies of TLR2-Arg753Gln and TLR4-Asp299Gly/Thr399Ile SNPs. Heterozygous and homozygous TLR4-Asp299Gly/Thr399Ile polymorphisms correlated with higher viral loads and delayed responses to antiviral therapy. We have provided the first evidence that TLR4 polymorphisms influence the success of antiviral therapy in our region. This suggests that therapeutic strategies should be adjusted not only according to HCV genotype but also to individual TLR polymorphism(s)
Single Nucleotide Polymorphism of Toll-like Receptor 4 (TLR4) is Associated with Juvenile Spondyloarthritis in Croatian Population
No full textSingle nucleotide polymorphisms (SNP) of toll-like and NOD-like receptors have been associated with altered receptor activity and modified production of proinflammatory cytokines leading to a number of diseases. Our aim was to determine whether SNP of TLR2 (Arg753Gln), TLR4 (Asp299Gly, Thr399Ile), and NLRP3 (Q705K) influence susceptibility to juvenile spondyloarthrtis (jSpA) and juvenile idiopathic arthritis (JIA). After the DNA extraction, 26 patients with jSpA, 11 with oligoarticular, polyarticular, or systemic JIA, and 40 healthy controls were genotyped for Arg753Gln, Asp299Gly, Thr399Ile, and Q705K SNP using real-time PCR-SNP analysis. Statistically significant difference in genotype frequency for Thr399Ile SNP of TLR4 was observed in the jSpA (χ2 = 6.705, p = 0.035) and not in the JIA group (χ2 = 3005, p = 0.223). Regarding Asp299Gly SNP, no significant difference in genotype frequency was found; however, allele frequency was significant in both jSpA and JIA patients. No significant difference in genotype or allele frequency was observed for Arg735Gln and Q705K SNP. The399Ile polymorphism of TLR4 may be responsible for altered immune response to microbial infection in variant carriers and represent a mechanism of triggering overproduction of proinflammatory cytokines and long-term inflammation in jSpA. SNP of TLR2, NLRP3, and TLR4 (Asp299Gly) were not associated with jSpA or JIA
Koincidencija između HLA-B27 negativnog spondiloartritisa i paravertebraline lokalizacije Non-Hodgkin-ovog limfoma - Lekcija koju bi trebalo naučiti iz prošlosti
No full textWe reported a case of a 71-year-old woman with progressive low back pain and neurologic symptoms of lower extremities, who in the background had the coexistence of spondyloarthritis (SpA) and non Hodgkin’s lymphoma of the paravertebral location. This example describes a situation where SpA with minimal sacroiliac joints affection has nevertheless led to the overt axial SpA. This situation included undifferentiated or reactive SpA, as well as unusual disease context, presented with late-life disease onset, older age, female gender and no obvious hereditary predisposition. This combination of comorbid factors could allow environmental and disease-specifi c factors to accumulate over time and to, by modifying the primary, low-penetrant genetic background, lead to the development of lymphoma. By achieving better understanding of disease pathophysiology dynamic, we will be able to improve our capabilities to navigate biologic therapy in the future, in order to prevent the development of both, overt SpA and lymphoproliferative disease.Prikazali smo slučaj 71-godišnje žene s progresivnim bolom u križima i neurološkim simptomima donjih ekstremiteta, čiju je pozadinu činila koegzistencija spondiloartritisa (SpA) i ne-Hodgkin-ova limfoma paravertebralne lokalizacije. Taj slučaj opisuje situaciju gdje je SpA s minimalnim promjenama na sakroilijačnim zglobovima ipak doveo do razvija uznapredovalog oblika aksijalnog SpA. Ta situacija je uključivala nediferencirani ili reaktivni SpA, kao i neuobičajeni klinički kontekst predstavljen kasnim početkom bolesti, starijom dobi, ženskim spolom i odsustvom nasljedne predispozicije bolesti. Takva kombinacija ko-morbiditetnih čimbenika je bila pogodna da omogući okolišnim i za bolest specifi čnim čimbenicima da se nakupljaju kroz vrijeme i da, modifi cirajući primarnu, slabo penetrirajuću genetsku podlogu, dovedu do razvoja limfoma. S boljim razumijevanjem patofi ziološke dinamike bolesti, poboljšat ćemo i našu sposobnost da specifi čno usmjeravamo biološku terapiju u budućnosti, da bi spriječili razvoj, kako uznapredovalog oblika SpA, tako i limfoproliferativne bolesti
Učestalost prijeloma kostiju u bolesnika na hemodijalizi: hrvatski rezultati
No full textDisturbances of bone mineral metabolism are common complications of chronic kidney disease with bone fractures as one of the most important consequences. The aim of this study was to estimate prevalence of bone fractures among Croatian hemodialysis patients and to determine the possible fracture risk. The study was carried out in 767 hemodialysis patients from nine Croatian hemodialysis centers. Demographic, laboratory and bone fracture data were collected from medical records as well as therapy with vitamin D analogs. Fragility fractures were defined according to the World Health Organization definition. In 31 patient a total of 36 fractures were recorded. The prevalence of patients with bone fractures was 4.0%. The mean age of patients with fractures was 68.6 years. There were 9 male and 22 female patients with frac- tures. The mean hemodialysis duration was 63.3 months. Among all fractures the most common were hip fractures (39%) followed by forearm fractures (22%). This is the first study regarding epidemiology of bone fractures in Croatian hemodialysis patients. The prevalence of patients with bone fractures in our group of hemodialysis patients is high. Fractures were more frequent among women and older patients, patients who have been longer on dialysis and in patients with higher concentration of PTH.Poremećaj mineralnog metabolizma kostiju česta je komplikacija kroničnog bubrežnog zatajenja s povećanim rizikom
prijeloma kostiju. Cilj ovog istraživanja je određivanje učestalosti bolesnika s prijelomima kostiju među hrvatskim bolesnicima
na hemodijalizi te ispitivanje čimbenika rizika za nastanak prijeloma. Istraživanje je provedno među 797 bolesnika na hemodijalizi u 9 hrvatskih centara za dijalizu. Pregledom medicinske dokumentacije zabilježeni su kliničkom obradom dokazani prijelomi kostiju, demografski podatci, laboratorijski podatci te podatci o terapiji analozima vitamina D. U tridesetjednog bolesnika zabilježeno je tridesetšest prijeloma. Učestalost bolesnika s prijelomima kostiju je 4,0%. Srednja dob bolesnika s prijelomima je 68,6 godina. Prijelomi su zabilježeni u devet muškaraca i dvadesetdvije žene. Srednje trajanje dijalize je 63,3 mjeseca. Najčešće zabilježeni prijelomi su prijelomi kuka (39%) i podlaktice (22%). 16 bolesnika s prijelomima je bilo na terapiji kalcitriolom ili parikalcitriolom u vrijeme nastanka prijeloma. Ovo je prvo istraživanje o prijelomima kod hrvatskih bolesnika na hemodijalizi. Učestalost bolesnika s prijelomima je visoka, prijelomi su učestaliji kod starijih bolesnika, žena, bolesnika koji su duže na dijalizi i bolesnika povišenim vrijednostima PTH
Od postporođajnog metastatskog tumora do adenoma paratireoidne žlijezde
No full textWe present a 36 year old female patient with suspected advanced postpartum metastatic cancer and multiple osteolytic lesions due to which she was referred to the Internal medicine clinic for further diagnostic evaluation. After extensive investigation, it was discovered that the underlying condition was a parathyroid gland adenoma and the patient was treated surgically. Clinicians should note that parathyroid adenoma can mimic metastatic malignant disease, and should make appropriate diagnostic tests that will lead to the correct diagnosis.Prikazuje se 36-godišnja bolesnica sa sumnjom na poslijeporođajni uznapredovali metastatski karcinom i s višestrukim osteolitičkim lezijama zbog čega je upućena na Internu kliniku radi daljnje dijagnostičke obrade. Nakon opsežne obrade, otkriveno je da se radi o adenomu paratireoidne žlijezde te je bolesnica operativno liječena. Kliničari trebaju imati na umu da adenom paratireoidne žlijezde može oponašati metastatsku malignu bolest te trebaju učiniti odgovarajuće dijagnostičke pretrage koje će uputiti na dijagnozu
Climatic Factors and Epidemiologic Characteristics of Head and Neck Skin Malignancies in Osijek Baranja County, Croatia
No full textAIM: The aim of this study was to investigate and compare the incidence and epidemiological characteristics of head and/or neck skin malignancies in Osijek-Baranja County, Croatia, and to connect them with relative climatic indicators such as the number and intensity of sunny and cloudy days over a longer period of time.
METHODS: The study included patients from Osijek Baranja County with confirmed pathohistological diagnosis of the head and/or neck malignancies from January 1, 2004 to December 31, 2012. The patients were analyzed according to gender, age, residence, occupation, type and location of the neoplasm, and hair and eye colour. The analysis of climatic elements (mean monthly and annual cloudiness values, mean monthly and annual sum values of sunny days) for a period of 50 years (1961-2011) based on the data of the Croatian Meteorological and Hydrological Service for the investigated area was performed.
RESULTS: The study included a total of 2,952 patients: 1,487 (50.4%) males and 1,465 (49.6%) females, representing the estimated annual incidence of 104/100,000. The mean age was 72 years. The patients were mostly from rural areas, 1,952 (66.2%); 2,137 (72.4%) worked outdoors: 907 farmers (42.4%) and 889 construction workers (41.6%). Given the type of neoplasm, the most common was a basal cell cancer (BCC) in 2,160 patients (73.2%). Malignant melanoma was found in 93 patients (3.1%). The most common localizations were face (839 cases, 28.7%) and nose (643 cases, 22.0%). Males had a significantly higher number of planocellular malignancies--341 (56.6%) than females--262 (43.4%) (p=0.005). The median age of the patients was 67 years. There were no significant differences in types of malignancies, place of residence, workplace, or occupation (with respect to working outdoors or indoors). It has been shown that the ears and lips are significantly more affected by squamous cell malignancies (p=0.039 and p<0.001) compared to the neck, eye and head with malignant melanoma (p=0.004, p<0.001, and p=0.026) and the nose where basal cell neoplasms (p=0.002) prevail. There were no significant differences in the type and frequency of malignant neoplasms in relation to hair and eye colour of the patients. The last 50 years in Osijek-Baranja County have seen a declining trend in the number of cloudy days and upward trend in the mean annual sum of sunny days. When compared, the increase in sunny days results in a higher number of patients suffering from malignant melanoma (ρ=0.695, p=0.038).
CONCLUSION: It is obvious that malignant neoplasms of the skin, head and neck occur after decades of exposure, and as a cumulative effect of exposure to risk factors. A direct exposure to sun seems to play an important role, especially with regard to melanoma. Nevertheless, further research is needed