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Minimally Invasive Direct Coronary Bypass Surgery via Distal Mini-sternotomy: Promising Clinical Results with Anaortic, Multivessel, All-arterial Technique
No full textBACKGROUND: Minimally invasive direct coronary artery bypass grafting (MIDCAB) was developed to decrease perioperative morbidity, some of which may be related to the use of cardiopulmonary bypass and to cross-clamping of the aorta. We report our initial experience with multivessel MIDCAB via distal mini-sternotomy (DIMS). DIMS is performed to gain access to the left and right internal thoracic arteries and to reach the left anterior descending coronary artery (LAD), diagonal branches, and right coronary artery (RCA).
METHODS: Between January 2016 and January 2017, 12 patients with significant coronary artery disease of the LAD and the RCA underwent multivessel, all-arterial MIDCAB through a distal midline skin incision from the fourth intercostal space to the xyphoid process, with L‑ or T‑shaped division of the sternum. The mean age of the patients was 61.5 ± 5.2 years (range: 52-71 years).
RESULTS: We performed all-arterial revascularization using the left internal mammary artery in 12 patients, the radial artery in ten, and the right internal mammary artery in two patients. The mean number of grafts per patient was 2.08 ± 0.4 (range: 2-3). The mean length of the skin incision was 8.5 ± 1.3 cm (range: 7-11 cm). There was no perioperative ischemia, postoperative bleeding, or arrhythmia events. No postoperative cognitive dysfunction occurred. The mean hospital stay was 5.6 days. No major adverse cardiac events (MACE) occurred at the 12-month follow-up. At follow-up, all patients were in New York Heart Association class I and there were no wound complications.
CONCLUSION: Although MIDCAB-DIMS is technically more demanding than conventional procedures and our experience is limited, we conclude that this technique can be used safely in selected patients, with promising 12-month follow-up results
Primary Care Provider Counseling Practices about Adverse Drug Reactions and Interactions in Croatia
No full textBACKGROUND: Prescribing medications is one of the most common medical decisions that is made by primary care providers (PCPs). In the Republic of Croatia, PCPs hold a key position in prescribing and evaluating the medications that are provided for patients. Accordingly, providing advice for patients regarding the potential adverse drug reactions (ADRs) and drug-drug interactions (DDIs) is frequently the responsibility of the PCPs. The aim of the current study was to assess the knowledge, attitudes, and counseling practices of PCPs regarding drug interactions and adverse effects.
METHODS: After enrolling 195 PCPs that were selected at random, a survey was conducted while using an anonymous questionnaire that was created based on previously published studies, adjusted in a way that includes the most commonly prescribed medications in Croatia.
RESULTS: Of the 10 questions on knowledge about DDIs and ADRs, the median number of correct responses by PCPs was 5 (interquartile range 4 to 7). More than half of respondents (56%) agreed with the claim that knowledge of drug side effects facilitated their work in family medicine. Almost all of the respondents (92.8%) explained side effects and drug interactions to special groups of patients (pregnant women, elderly patients etc.).
CONCLUSION: The results show a need for additional education in the field of drug prescribing. However, PCPs were aware of the importance of counseling practices about adverse drug reactions and interactions and counseling practices among special patients populations are satisfactory
Leptin/adiponectin Ratio in Overweight Patients - Gender Differences
No full textOBJECTIVE: Obesity-related atherosclerosis is a systemic disease with a background connected to multiple metabolic-neurohumoral pathways. The leptin/adiponectin ratio has been suggested as an atherosclerotic marker in obese patients. The aim of this study was to assess (1) the significance of the L/A ratio in overweight subjects, (2) the relation with anthropometric/metabolic parameters and (3) gender difference.
METHOD: The study included 80 adult males and females, overweight, non-diabetic patients. Biochemical blood analysis and anthropometric and cardiovascular measurements were performed. Serum leptin levels were measured with a radioimmunoassay test and total adiponectin levels with enzyme-linked immunosorbent assay. Leptin/adiponectin ratios were calculated as ratios between total serum concentrations of leptin and adiponectin.
RESULTS: Differences between leptin, adiponectin serum levels and leptin/adiponectin ratios are presented in overweight persons, where females have a significantly higher leptin/adiponectin ratio than men ( p < 0.001). In men, the leptin/adiponectin ratio showed a positive correlation with total cholesterol levels ( p = 0.011), low-density lipoprotein ( p = 0.013) and triglycerides ( p = 0.032). In females, the leptin/adiponectin ratio correlated with anthropometric parameters of visceral obesity: waist circumference ( p = 0.001) and waist-to-hip ratio ( p = 0.025).
CONCLUSION: The leptin/adiponectin ratio could represent an atherosclerotic risk marker of the early stage of obesity. Gender plays a significant role in pathophysiological changes, with different clinical manifestations, where sex hormones have a crucial effect on neurohumoral adipose tissue activity
Ethics in solid organ transplantation
No full textTransplantacijska etika (TE) određena je brojnim povijesnim, filozofskim, znanstvenim, medicinskim, pravnim, sociološkim i ekonomskim čimbenicima. Nacionalne posebnosti Republike Hrvatske (RH) u ovom se području temelje na zavidnom uspjehu u transplantaciji (TX) solidnih organa i uređenoj relevantnoj legislativi koja pogoduje ovom uspjehu. Tako problemi nedostatka organa za TX, doniranja, dodjele i pravedne raspodjele nisu važne teme TE-a u RH, ali globalno ostaju vodeća etička područja u TX-u. U RH je na snazi uzorit Zakon o presumptivnom pristanku na doniranje organa nakon smrti (tzv. zakon opt-out, jer se izjašnjavanje traži za „biti izvan – out” mogućih darovatelja). Nepoznavanje zakona opt-out o doniranju organa nakon moždane smrti, vrijedećega u RH, neusklađenost s običajima i odredbom Kodeksa medicinske etike i deontologije o traženju suglasnosti obitelji za doniranje organa nakon moždane smrti te nedovoljno regrutiranje kandidata za TX u nas se nameću kao sporne etičke teme. Budućnost predviđa mogućnost TX-a organom nehumanog podrijetla kao što je onaj uzgojen u svinjskom organizmu, što otvara nova etička područja i za RH i za ostatak svijeta.Ethics in transplantation (TX) has been determined by history, philosophy, science, medicine, law, sociology and economics. Croatian national peculiarities are based on the excellent achievements in solid organ TX and outstanding legislation, which supports this success. Thus the prevalent ethical issues in TX at global level, such as organ shortage, donation, allocation and distributive justice, are simply not of major importance in Croatia. There is a model law on presumptive consent for organ donation after death in Croatia (so called “opt-out” law, while a person should declare only if willing to be “out” of the possible donors’ pool). Lack of knowledge of the opt-out law of organ donation after brain death, which is currently established in Croatia, lack of coordination of this law with Croatian Codex of Medical Ethics and Deontology in regard to family permission for organ donation after brain death arise as our particular ethical questions along with insufficient patients’ recruitment as candidates for TX. It is expected to have TX with organs of non-human origin in the future,like the one bred in a swine, which may raise new ethical concerns
Overlapping Phenotypes and Degree of Ventricular Dilatation are Associated with Severity of Systolic Impairment and Late Gadolinium Enhancement in Non-Ischemic Cardiomyopathies
No full textBackground: Dilatation and other infrastructural rearrangements of the left ventricle are connected with poor prognosis. The aim of our study was to analyze the overlapping phenotypes and dilatation of the ventricle on impairment of systolic function and existence of late gadolinium enhancement (LGE).
Material/Methods: Consecutive sample of cases with dilated left ventricle due to non-ischemic cardiomyopathy and healthy controls were included from our cardiac magnetic resonance imaging (CMR) database for a period of 3 years (n=1551 exams).
Results: The study included 127 patients; 30 (23.6%) with dilated cardiomyopathy (DCM); 30 (23.6%) with left ventricular
non-compaction (LVNC); 13 (10.2%) with hypertrophic cardiomyopathy (HCM), and 50 (39.4%) controls. Overlapping phenotypes were found in 48 (37.8%) of the studied cases. Odds for impairment of systolic function in connection with overlapping phenotypes were estimated at 7.8 (95%-CI: 3.4–17.6), (p<0.001). There were significant differences in geometric parameters for patients with overlapping phenotypes vs. controls, as follows: left ventricle end-diastolic dimension(LVEDD)=6.6±0.8 vs. 5.6±1.0 cm (p<0.001); left ventricular ejection fraction (LVEF)=39.3±14.0 vs. 52.1±16.1 (p<0.001); and existence of LGE 36 (75.0%) vs. 21 (26.6%), (p<0.001), respectively. Overlapping phenotypes correlated with LVEDD (Spearman’s-Rho-CC)=0.521, p<0.001; LVEF (Rho- CC)=–0.447, p<0.001 and LGE (Rho-CC)=0.472, p<0.001.
Conclusions: This study found there are many patients with overlapping phenotypes among NICMPs with dilated left ventricles. Overlapping phenotype was associated with greater LVEDD, lesser systolic function, and commonly existing
LGE, which all impose increased cardiovascular risk. Linear midventricular LGE stripe was the most powerfully connected with loss of systolic function
Traganje za neinvazivnom procjenom mišićne slabosti tijekom rada: pruža li rasap podataka visoke rezolucije o električnoj aktivnosti mišića novi uvid?
No full textParalumbar muscle performance and fatigue were evaluated by measuring electromagnetic activity during entire body vibration (EBV) in 44 healthy subjects. Physical fitness of subjects was estimated on a 5-degree scale. Electric activity was recorded in 200 seconds with 1 kHz sampling on the Biopac Student Lab during EBV. Data were used to produce time series for two vectors of the phase space and spatial axis: X (left-right), Y (up-down) and Z (ventral-dorsal). Time series were evaluated by calculating fractal dimension by the R/S algorithm. Movement of the electric field along the Y-axis showed changes (up-down) extracted in the first and second quarter of the measurement (p=0.02 and p=0.03, respectively). These changes were not specific for gender but showed dependence on subject age and fitness. The fractal dimension values by the R/S algorithm were larger in female subjects. Results suggested the electric field changes during EBV in the up-down direction to contain information on muscular performance and fatigue, not dependent on gender, but on the age and degree of overall physical fitness.Istraživanje električnog polja paralumbalne muskulature kao pokazatelja umaranja provedeno je na 44 zdrava ispitanika, pri čemu je utreniranost njihove paralumbalne muskulature procijenjena anamnestički ljestvicom od 5 stupnjeva. Električna aktivnost snimana je uređajem Biopac Student Lab i uporabom tri para elektroda postavljenih duž osi faznog prostora. Iz prikupljenih podataka izostavljeni su dijelovi koji odgovaraju QRS kompleksu EKG-a i rekonstruirani sljedovi pet različitih načina mjerenja električne aktivnosti, pri čemu su za prva tri izdvojeni zapisi za svaku os. Za os X lijevo i desno, za os Y gore i dolje te za os Z naprijed i nazad, a izračunata su i dva vektora. Iz tako dobivenih vremenskih serija računala se fraktalna dimenzija R/S algoritmom. Od rezultata izračunom fraktal-ne dimenzije zapisa R/S algoritmom izdvaja se kretanje električnog polja duž osi Y (gore-dolje) u prvoj i drugoj četvrtini mjerenja (p=0,02 odnosno p=0,03). Rezultati su se pokazali neovisnima o spolu, ali ovisnima o godinama i utreniranosti ispitanika. Vrijednosti fraktalne dimenzije po R/S algoritmu u žena su bile veće. Navedeno upućuje na to da podaci o kretanju položaja mjerenja duž osi Y (gore-dolje) u sebi sadrže informacije o načinu umaranja muskulature koje nisu ovisne o spolu, nego o dobi i stupnju utreniranosti
Models of Drug Induced Liver Injury (DILI) - Current Issues and Future Perspectives
No full textBACKGROUND: Drug-induced Liver Injury (DILI) is an important cause of acute liver failure cases in the United States, and remains a common cause of withdrawal of drugs in both preclinical and clinical phases.
METHODS: A structured search of bibliographic databases - Web of Science Core Collection, Scopus and Medline for peer-reviewed articles on models of DILI was performed. The reference lists of relevant studies was prepared and a citation search for the included studies was carried out. In addition, the characteristics of screened studies were described.
RESULTS: One hundred and six articles about the existing knowledge of appropriate models to study DILI in vitro and in vivo with special focus on hepatic cell models, variations of 3D co-cultures, animal models, databases and predictive modeling and translational biomarkers developed to understand the mechanisms and pathophysiology of DILI are described.
CONCLUSION: Besides descriptions of current applications of existing modeling systems, associated advantages and limitations of each modeling system and future directions for research development are discussed as well
Ventricular Diastolic Dimension over Maximal Myocardial Thickness is Robust Landmark of Systolic Impairment in Patients with Hypertrophic Cardiomyopathy
No full textBackground: The effects of focal hypertrophy on geometry of the left ventricle and systolic function have not been studied in patients with hypertrophic cardiomyopathy (HCM), despite the fact that the former is the most prominent disease characteristic. The aim of our study was to analyze systolic function over ventricle geometry, generating a functional index made from left ventricle end diastolic dimension (LVEDD) divided by end diastolic thickness of the region with maximal extent of hypertrophy and interventricular septum.
Material/Methods: Our hospital database of cardiac magnetic resonance was screened for HCM. Geometric functional index (GFI) was calculated for LVEDD over maximal end diastolic thickness (MaxEDT) giving GFI-M, while LVEDD over interventricular septum was expressed as GFI-I. There were 55 consecutive patients with HCM.
Results: There were 43 males (78.2%) and 12 females (21.8%). The mean age was 52.3±16.7 years (range: 15.5–76.4 years). A significant difference of GFI was found for preserved versus impaired systolic function of the left ventricle (preserved systolic function); GFI-M 2.28±0.60 versus 3.66±0.50 (p<0.001), and GFI-I 2.75±0.88 versus 3.81±0.87 (p<0.001), respectively. Diagnostic value was tested using receiver operating curve (ROC) analyzes, with GFI-M area under curve (AUC)=0.959 (95% CI: 0.868–0.994); (p<0.001) and GFI-I-AUC=0.847 (0.724–0.930); (p<0.001). GFI-M was superior to GFI-I for appraisal of left ventricle systolic dysfunction in HCM; DAUC=0.112 (0.018–0.207); (p=0.020).
Conclusions: GFI is a simple tool, with high sensitivity and specificity for detecting impairment of systolic function in patients
with HCM. Further studies would be necessary to investigate its clinical and prognostic impacts, as well as reproducibility with prospective validation
The Quality of Life of Croatian Women after Mastectomy: a Cross-sectional Single-center Study
No full textBACKGROUND: Measuring the quality of life (QoL) of women with breast cancer is an important aspect of measuring treatment success. In Croatia, no QoL studies have been carried out with a focus on patients after mastectomy. The aim of this study was to examine QoL 1 month and 1 year after mastectomy.
METHODS: This cross-sectional single-center study of quality of life was conducted in 101 patients, 50 of whom had undergone a mastectomy 1 month prior, and 51 of whom had undergone a mastectomy 1 year prior. The study was conducted from July 2015 to June 2016. The questionnaires used in the study were developed by the European Organisation for Research and Treatment of Cancer (EORTC). The questionnaire EORTC QLQ-C30 assesses the QoL of cancer patients, and the questionnaire EORTC QLQ-BR23 is a disease-specific breast cancer module. A chi square test, Fisher's exact test, Kolmogorov-Smirnov test, Student's t-test and Mann-Whitney U test were performed in the statistical analysis using the statistical program SPSS (Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc.).
RESULTS: Patients who had undergone a mastectomy a year earlier placed a higher value on their health state than did those who had undergone a mastectomy a month earlier. The most affected values of functional status on the EORTC QLQ-C30 scale were emotional functioning (37.5 [95% CI 33.3-61.6]) and sexual functioning (16.67 [95% CI 0-33.3]) 1 month and 1 year after mastectomy, respectively. The most affected symptoms on the EORTC QLQ-C30 scale were hair loss 66.67 [95% CI 33.3-100]) and fatigue 33.33 [95% CI 24-44]) 1 month and 1 year after mastectomy, respectively.
CONCLUSION: In our study, both functional and symptom scales were more affected in women 1 month after mastectomy. QoL was considerably improved in women 1 year after the surgery compared to 1 month after mastectomy. The results of this study could contribute to the public awareness of the QoL of breast cancer patients
Effect of Pre-emptive Paracetamol Infusion on Postoperative Analgesic Consumption in Children Undergoing Elective Herniorrhaphy
No full textOBJECTIVE: Studies have suggested that pre-emptive analgesia may decrease postoperative pain and opioid consumption. This study was undertaken to determine whether pre-emptive analgesia reduces postoperative pain and total paracetamol and opioid consumption in children undergoing herniorrhaphy.
METHODS: In this retrospective study, medical records were analysed before and after the pre-emptive analgesia regimen was introduced. Demographic data, perioperative drug consumption and discharge time were recorded. In the first group, no pre-emptive analgesia (NA; year, 2011; n=60) was given and in the second group, the pre-emptive analgesia (PA) paracetamol 10-15 mg kg-1 was given intravenously in the surgical ward at least 1 h before the surgical procedure (year 2013; n=60). Postoperative pain determining supplemental pain medications was scored using a Faces Pain Scale or visual analogue scale. Total paracetamol and opioid consumption during 24 perioperative hours was registered for all patients. The statistical analysis was performed using t test and Chi-square test.
RESULTS: The mean age of children was 69.6±49.9 and 58.7±32.4 months (p=0.157), and the mean body mass index (BMI) was 18.3±8.8 kg m-2 and 16.4±3.7 kg m-2 (p=0.125) in the NA and PA groups, respectively. Total paracetamol consumption was 1157.8±908.8 mg vs. 983.0±536.4 mg (p=0.202), and the total opioid consumption was 5.8±4.7 in the NA group and 7.0±4.6 morphine equivalents in the PA group (p=0.160). No differences in the discharge time between the groups were observed (2.1±0.3 vs. 2.0±0.3 days, p=0.13).
CONCLUSION: PA was proven to be efficient in the terms of postoperative pain control but did not reduce the overall analgesic drug consumption in the children undergoing elective herniorrhaphy. Multimodal pain treatment may decrease the consumption of analgesic drugs