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Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion
Get PDFDespite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The "surgeon champion" can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship
Educational landscape of biomedical informatics in Croatia: who are the teachers and what are their attitudes
Get PDFLack of experts with complementary competences in the field of information technology as well as medicine and health care has been recognised as an important obstacle to successful computerisation of the health care system. Using a questionnaire survey, we aimed to describe the current educational landscape of biomedical informatics in Croatia, focussing on teachers' profiles and attitudes about existing educational opportunities in the field. Our findings show that Croatian institutions of higher education should better recognise the need for education in biomedical informatics. Dedicated programs need to be established and teacher force strengthened. Joint efforts of existing teachers-institutionalised through a working group focussing on education within the Croatian Society for Medical Informatics, for which strong support exists-might contribute to recognition of the field and improvement of educational opportunities
Smjernice za provođenje dijagnostičkih pretraga prije početka liječenja onkološkog bolesnika – kliničke preporuke Hrvatskog društva za internističku onkologiju HLZ-a I. dio: tumori urogenitalnog sustava (rak bubrega, rak mokraćnog mjehura, rak prostate, rak testisa), tumori probavnog sustava (rak jednjaka, rak želuca, rak debelog i završnog crijeva, rak gušterače, rak žučnih vodova, hepatocelularni rak, neuroendokrine novotvorine) [Guidelines for usage of diagnostic procedures prior to initiation of antineoplastic treatment – Croatian society for medical oncology clinical recommendations Part I. tumors of urogenital system (renal cell cancer, urinary bladder cancer, prostatic cancer, testicular cancer), tumors of gastrointestinal system (oesophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer, biliary ducts cancer, hepatocellular cancer, neuroendocrine neoplasms)]
Get PDFCancer is the second most important cause of death in our country, immediately after cardiovascular diseases. With the assumption that cancer incidence and mortality will increase in the next years, projections show that the costs of diagnosis and treatment of cancer will be significantly increased, both due to the introduction of new diagnostic techniques and innovative medicines and treatment methods. Consequently, the imperative of making optimal use of financial resources, available personnel and techniques is all the more necessary in or-der to ensure the continuity of adequate diagnosis and treatment. Optimal use of diagnostic methods can pre-vent unnecessary processing delay, waste of financial resources and unnecessary burden on healthcare work-ers, and shorten waiting lists. HDIO has made these guidelines with the aim of overcoming these problems, rationalizing and standardizing diagnostic procedures in everyday clinical practice. Guidelines should help us to select, from the entire range of diagnostic procedures available, those which are most relevant to a particular localization and clinical extension of the disease
Alvaradov sustav bodovanja u djece s akutnom upalom crvuljka [Alvarado score in children with diagnosis of acute appendicitis]
Get PDFThe Alvarado scoring (AS) system was created with the intention to reduce the number of negative appendec-tomies. It is used in both the adult and pediatric populations, but the number of negative appendectomies is rarely lower than 10%. In order to test the reliability of the system, an analysis was done on the correlation of the Alvarado score and the histological diagnoses of children who underwent appendectomy for suspected acute appendicitis. This retrospective study was conducted at the Department of Pediatric Surgery of the Uni-versity Hospital Center Zagreb in the period between January 2014 and December 2016, and included 330 children with the clinical diagnosis of acute appendicitis. The children were included regardless of the method of appendectomy. As 39 of them were excluded due to incomplete medical records, only 291 children were analyzed. Each appendix was subjected to postoperative histological examination, after which the final diagno-sis was made. Abdominal ultrasound was performed in 160 children to detect whether there were signs of ap-pendicitis. 291 appendices were histologically examined, of which 35 (12%) were without inflammatory signs, 44 (15.1%) were in the catarrhal, 153 (52.6 %) in the phlegmonous, and 58 (19.9 %) in the gangrenous stage of inflammation; one boy (0.3 %) had a perforated appendix. The average value of the Alvarado score in children with histologically innocent or catarrhal appendix was 6, in those with phlegmonous 7, and in those with gangrenous 8. The boy with the perforated appendix had a score 6. Sensitivity, specificity, and positive predictive value (PPV) with the cut-point of 7, as well as negative predictive value (NVP) with the cut-point of 5, were analyzed. In the tested group, AS sensitivity and specificity were 68.9% and 52.9%, respec-tively. Positive predictive value was 91.7% and negative predictive value was 99%. AS was statistically signifi-cantly higher in children with phlegmonous appendicitis than in those with innocent appendix (p = 0.003) or with a catarrhal stage of inflammation (p = 0.007), as well as in children with gangrenous appendicitis com-pared to those with innocent and catarrhal appendicitis (p < 0.001). There was no statistically significant dif-ference between AS in children with phlegmonous and gangrenous appendicitis (p = 0.054), and neither be-tween AS in those with catarrhal and innocent appendix (p = 0.998). The abdominal ultrasound examination was performed preoperatively in 160 (54.9%) of all operated children. Only 82 (51.2%) of all ultrasound find-ings were consistent with the final histological diagnosis. Among those incongruous findings, there were 64 (40%) false negative and 14 (8.8%) false positive ones. Ultrasound showed the presence of appendicitis with a PPV of 84.1%, but for exclusion of the diagnosis NPV was 11.1 %. AS is not a reliable clinical indicator of the inflammatory signs of appendicitis in children, but still has a high predictive value for negative appendecto-mies
Biphasic dendritic growth of dorsolateral prefrontal cortex associative neurons and early cognitive development
Get PDFAim: To analyze postnatal development and life-span changes of apical dendrite side branches (oblique dendrites) from associative layer IIIC magnopyramidal neurons in the human dorsolateral prefrontal cortex and to compare the findings with the previously established pattern of basal dendrite development. Methods: We analyzed dendritic morphology from 352 rapid-Golgi impregnated neurons (10-18 neurons per subject) in Brodmann area 9 from the post-mortem tissue of 25 subjects ranging in age from 1 week to 91 years. Data were collected in the period between 1994 and 1996, and the analysis was performed between September 2017 and February 2018. Quantitative dendritic parameters were statistically analyzed using one-way analysis of variance and two-tailed t tests. Results:
Oblique dendrites grew rapidly during the first postnatal months, and the increase in the dendrite length was accompanied by the outgrowth of new dendritic segments. After a more than one-year-long “dormant” period of only fine dendritic rearrangements (2.5-16 months), oblique dendrites displayed a second period of marked growth, continuing through the third postnatal year. Basal and oblique dendrites displayed roughly the same growth pattern, but had considerably different topological organization in adulthood. Conclusion: Our analysis confirmed that a biphasic pattern of postnatal dendritic development, together with a second growth spurt at the age of 2-3 years, represents a unique feature of the associative layer IIIC magnopyramidal neurons in the human dorsolateral prefrontal cortex. We propose that these structural changes relate to rapid cognitive development during early childhood
Interactive histogenesis of axonal strata and proliferative zones in the human fetal cerebral wall
Get PDFDevelopment of the cerebral wall is characterized by partially overlapping histogenetic events. However, little is known with regards to when, where, and how growing axonal pathways interact with progenitor cell lineages in the proliferative zones of the human fetal cerebrum. We analyzed the developmental continuity and spatial distribution of the axonal sagittal strata (SS) and their relationship with proliferative zones in a series of human brains (8-40 post-conceptional weeks; PCW) by comparing histological, histochemical, and immunocytochemical data with magnetic resonance imaging (MRI). Between 8.5 and 11 PCW, thalamocortical fibers from the intermediate zone (IZ) were initially dispersed throughout the subventricular zone (SVZ), while sizeable axonal "invasion" occurred between 12.5 and 15 PCW followed by callosal fibers which "delaminated" the ventricular zone-inner SVZ from the outer SVZ (OSVZ). During midgestation, the SS extensively invaded the OSVZ, separating cell bands, and a new multilaminar axonal-cellular compartment (MACC) was formed. Preterm period reveals increased complexity of the MACC in terms of glial architecture and the thinning of proliferative bands. The addition of associative fibers and the formation of the centrum semiovale separated the SS from the subplate. In vivo MRI of the occipital SS indicates a "triplet" structure of alternating hypointense and hyperintense bands. Our results highlighted the developmental continuity of sagittally oriented "corridors" of projection, commissural and associative fibers, and histogenetic interaction with progenitors, neurons, and glia. Histogenetical changes in the MACC, and consequently, delineation of the SS on MRI, may serve as a relevant indicator of white matter microstructural integrity in the developing brain
Intracranial epidural haematoma following surgical removal of a giant lumbosacral schwannoma: a case report and literature review.
Get PDFPostoperative intracranial epidural haematoma (EDH) is an extremely rare complication following spinal surgery, with only a handful of cases described in the literature. We report the case of a 16-year-old girl who underwent a successful subtotal resection of a giant lumbosacral schwannoma (L2-S2 level). Recovery from general anaesthesia was uneventful; however, her neurological status deteriorated rapidly within 24 h after surgery. A head computed tomography scan revealed a large right frontoparietal EDH with midline shift. An immediate frontotemporoparietal osteoplastic craniotomy and evacuation of the EDH were performed. At 1 year postoperatively, the patient regained full neurological recovery with no radiological signs of growth of the residual tumour
The long Pentraxin 3 plays a role in bone turnover and repair
Get PDFPentraxin 3 (PTX3) is an inflammatory mediator acting as a fluid-phase pattern recognition
molecule and playing an essential role in innate immunity and matrix remodeling.
Inflammatory mediators also contribute to skeletal homeostasis, operating at multiple
levels in physiological and pathological conditions. This study was designed to investigate
the role of PTX3 in physiological skeletal remodeling and bone healing. Micro-computed
tomography (μCT) and bone histomorphometry of distal femur showed that PTX3
gene-targeted female and male mice (ptx3−/−) had lower trabecular bone volume than
their wild-type (ptx3+/+) littermates (BV/TV by μCT: 3.50 ± 1.31 vs 6.09 ± 1.17 for females,
p < 0.0001; BV/TV 9.06 ± 1.89 vs 10.47 ± 1.97 for males, p = 0.0435). In addition, μCT
revealed lower trabecular bone volume in second lumbar vertebra of ptx3−/− mice. PTX3
was increasingly expressed during osteoblast maturation in vitro and was able to reverse
the negative effect of fibroblast growth factor 2 (FGF2) on osteoblast differentiation. This
effect was specific for the N-terminal domain of PTX3 that contains the FGF2-binding site.
By using the closed transversal tibial fracture model, we found that ptx3−/− female mice
formed significantly less mineralized callus during the anabolic phase following fracture
injury compared to ptx3+/+ mice (BV/TV 17.05 ± 4.59 vs 20.47 ± 3.32, p = 0.0195). Nonhematopoietic
periosteal cells highly upregulated PTX3 expression during the initial phase
of fracture healing, particularly CD51+ and αSma+ osteoprogenitor subsets, and callus
tissue exhibited concomitant expression of PTX3 and FGF2 around the fracture site.
Thus, PTX3 supports maintenance of the bone mass possibly by inhibiting FGF2 and its
negative impact on bone formation. Moreover, PTX3 enables timely occurring sequence
of callus mineralization after bone fracture injury. These results indicate that PTX3 plays
an important role in bone homeostasis and in proper matrix mineralization during fracture
repair, a reflection of the function of this molecule in tissue homeostasis and repair
Perspectives of patients with insulin-treated type 1 and type 2 diabetes on hypoglycemia: results of the HAT observational study in Central and Eastern European countries
Get PDFINTRODUCTION: The aim of this study was to
determine the level of awareness of hypoglycemia,
the level of fear for hypoglycemia,
and the response to hypoglycemic events
among insulin-treated diabetes patients from
Central and Eastern Europe (CEE). The impact
of hypoglycemia on the use of healthcare
resources and patient productivity was also
assessed. ----- METHODS: This was a multicenter, non-interventional,
two-part, patient self-reported questionnaire
study that comprised both a
retrospective cross-sectional evaluation and a
prospective observational evaluation. Study
participants were insulin-treated adult patients
with type 1 diabetes mellitus (T1DM) or type 2
diabetes mellitus (T2DM) from CEE. ----- RESULTS: Most patients (85.4% T1DM and 83.6% T2DM) reported normal hypoglycemia
awareness. The median hypoglycemia fear score
was 5 out of 10 for T1DM and 4 out of 10 for
T2DM patients. Patients increased glucose
monitoring, consulted a doctor/nurse, and/or reduced the insulin dose in response to hypoglycemia.
As a consequence of hypoglycemia,
patients took leave from work/studies or arrived
late and/or left early. Hospitalization was
required for 31 (1.2%) patients with T1DM and
66 (2.1%) patients with T2DM. ----- CONCLUSION: Hypoglycemia impacts patients’
personal and social functioning, reduces productivity,
and results in additional costs, both
direct (related to increased use of healthcare
resources) and indirect (related to absenteeism)