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Smjernice ISKRA za dijagnostiku i liječenje prostatitisa – hrvatske nacionalne smjernice [ISKRA guidelines on diagnostics and treatment of prostatitis – croatian national guidelines]
Get PDFThese guidelines refer to classification, diagnostics and treatment of prostatitis syndrome. The aim of these guidelines is the standardization, harmonization and optimization of diagnostics, treatment and monitoring of patients with prostatitis that would lead to improved quality of health care for these patients and promote rational use of antibiotics. The guidelines are primarily intended for general practitioners and specialists working in primary health care and hospitals. The members of the Working Group (WG) for the development of guidelines on diagnostics and treatment of prostatitis were appointed by the Croatian Ministry of Health. The evidence for these guidelines was identified by systematic review of the literature, local antibiotic resistance data, existing clinical protocols for diagnostics and treatment of prostatitis, as well as suggestions and comments from colleagues physicians. Through continuing medical education courses, the guidelines were widely presented to family medicine physicians and specialists working in primary health care and hospitals – urologists, infectious disease specialists, microbiologists and nephrologists. The final version of the guidelines was reviewed and approved by members of the Intersectoral Coordination Mechanism for the Control of Antimicrobial Resistance (ISKRA). These guidelines also present clinical instructions aimed at standardizing the procedures and criteria for diagnosis and treatment of patients with prostatitis in Croatia
Video head impulse test – „očni EKG“ [Video head impulse test – eye]
Get PDFIn the diagnosis of acute vestibular syndrome (AVS) the key part is a quick and reliable differentiation between peripheral and central etiologies. Video head impulse test (vHIT) is a new method that is based on the examination of rotational vestibulo-ocular reflex. vHIT has demonstrated high specificity for peripheral vestibular damage. Several studies have shown a broad applicability for vHIT, with an emphasis on potential use in the emergency department. It has been called “eye ECG” due to the speed and simplicity of this method use in AVS. However, vHIT is not a replacement for other methods in vestibular testing battery, rather their supplement. As a part of the HINTS (Head impulse, Nystagmus, Test of Skew) protocol it has shown higher sensitivity and specificity than diffusion weighted brain MRI in the detection of stroke with isolated vertigo. It is still under-utilized in the emergency department compared to the potential benefits it carries
The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey
Get PDFBACKGROUND:
Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. -----
METHODS:
A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. -----
RESULTS:
The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). -----
CONCLUSION:
The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal
Biochemical markers in vascular cognitive impairment associated with subcortical small vessel disease - a consensus report
Get PDFBACKGROUND:
Vascular cognitive impairment (VCI) is a heterogeneous entity with multiple aetiologies, all linked to underlying vascular disease. Among these, VCI related to subcortical small vessel disease (SSVD) is emerging as a major homogeneous subtype. Its progressive course raises the need for biomarker identification and/or development for adequate therapeutic interventions to be tested. In order to shed light in the current status on biochemical markers for VCI-SSVD, experts in field reviewed the recent evidence and literature data. -----
METHOD:
The group conducted a comprehensive search on Medline, PubMed and Embase databases for studies published until 15.01.2017. The proposal on current status of biochemical markers in VCI-SSVD was reviewed by all co-authors and the draft was repeatedly circulated and discussed before it was finalized. -----
RESULTS:
This review identifies a large number of biochemical markers derived from CSF and blood. There is a considerable overlap of VCI-SSVD clinical symptoms with those of Alzheimer's disease (AD). Although most of the published studies are small and their findings remain to be replicated in larger cohorts, several biomarkers have shown promise in separating VCI-SSVD from AD. These promising biomarkers are closely linked to underlying SSVD pathophysiology, namely disruption of blood-CSF and blood-brain barriers (BCB-BBB) and breakdown of white matter myelinated fibres and extracellular matrix, as well as blood and brain inflammation. The leading biomarker candidates are: elevated CSF/blood albumin ratio, which reflects BCB/BBB disruption; altered CSF matrix metalloproteinases, reflecting extracellular matrix breakdown; CSF neurofilment as a marker of axonal damage, and possibly blood inflammatory cytokines and adhesion molecules. The suggested SSVD biomarker deviations contrasts the characteristic CSF profile in AD, i.e. depletion of amyloid beta peptide and increased phosphorylated and total tau. -----
CONCLUSIONS:
Combining SSVD and AD biomarkers may provide a powerful tool to identify with greater precision appropriate patients for clinical trials of more homogeneous dementia populations. Thereby, biomarkers might promote therapeutic progress not only in VCI-SSVD, but also in AD
A case report of acute inferior myocardial infarction in a patient with severe hemophilia A after recombinant factor VIII infusion
Get PDFRATIONALE: The extent of protective effects of hemophilia against thrombotic events such as myocardial infarction (MI) and other acute coronary syndromes remains to be determined, as major risk factors for cardiovascular disease exist despite factor VIII (FVIII) deficiency. We present a case report of a 41-year-old male with severe hemophilia A and several cardiovascular risk factors. ----- PATIENT CONCERNS: This morbidly obese patient developed chest pressure, followed by chest pain and difficulty in breathing shortly after receiving on-demand treatment with intravenous recombinant FVIII (rFVIII) (turoctocog alfa) dosed per body weight. ----- DIAGNOSES: An electrocardiogram revealed a diagnosis of inferior ST-segment elevation MI. ----- INTERVENTIONS: The patient underwent an urgent coronary angiography using a radial artery approach. During the next 12 months, he received dual antiplatelet treatment, acetylsalicylic acid 100 mg, and clopidogrel 75 mg daily. His treatment for severe hemophilia A was changed to plasma-derived FVIII replacement therapy. -----OUTCOMES:
During this 12-month period, he experienced several small bleeds in his elbows. ----- CONCLUSIONS: The temporal relationship between rFVIII infusion and onset of the MI suggests a possible association; however, apart from obesity, the patient also had other major risk factors for arterial thrombosis, such as hypertension and smoking. Furthermore, atherosclerotic disease and underlying atherosclerotic changes could not be excluded with certainty. This case highlights the importance of studies assessing the impact of excess body weight on rFVIII dosing
A novel adjustable automated system for inducing chronic intermittent hypoxia in mice
No full textBACKGROUND:
Sleep apnea is a chronic, widely underdiagnosed condition characterized by disruption of sleep architecture and intermittent hypoxia due to short cessations of breathing. It is a major independent risk factor for myocardial infarction, congestive heart failure and stroke as well as one of the rare modifiable risk factors for Alzheimer's Dementia. Reliable animal disease models are needed to understand the link between sleep apnea and the various clinically linked disorders. -----
NEW METHOD:
An automated system for inducing hypoxia was developed, in which the major improvement was the possibility to efficiently adjust the length and intensity of hypoxia in two different periods. The chamber used a small volume of gas allowing for fast exchanges of different oxygen levels. The mice were kept in their cages adapted with the system on the cage lid. As a proof of principle, they were exposed to a three week period of intermittent hypoxia for 8 hours a day, with 90 s intervals of 5, 7% and 21% oxygen to validate the model. Treated (n = 8) and control mice (no hypoxia, n = 7) were handled in the same manner and their hippocampal brain regions compared by histology. -----
RESULTS:
The chamber provided a fast, reliable and precise intermittent hypoxia, without inducing noticeable side effects to the animals. The validation experiment showed that apoptotic neurons in the hippocampus were more numerous in the mice exposed to intermittent hypoxia than in the control group, in all tested hippocampal regions (cornu ammonis 1 (CA1) P <0.001; cornu ammonis 3 (CA3) P <0.001; and dentate gyrus (DG) P = 0.023). In both, control and hypoxic conditions, there was a significantly higher number of apoptotic neurons in the DG compared to the CA1 and CA3 subfields (P <0.001). -----
CONCLUSION:
The new design of a hypoxic chamber provides a fast, adjustable and reliable model of obstructive sleep apnea, which was validated by apoptosis of hippocampal neurons
Utjecaj gestacijske dobi i broja pregleda fetalnom ehokardiografijom na poboljšanu dijagnostiku prirođenih srčanih bolesti kod fetusa [The role of gestational age and number of fe examinations in improving diagnosing of fetal congenital heart disease]
Get PDFDescriptive study: The role of gestational age and number of FE examinations in improving detection of congenital heart defects in newborns. According to the literature data, fetal echocardiography (FE) is highly sensitive in detecting congenital heart defects (CHDs) between 20 and 24 weeks of gestation. Its sensitivity depends on timing of the examination, diagnostician’s experience, type of CHD, and the number of examinations performed in a single pregnant woman. The aim of our study was to determine the best time for FE examination, as well as possible need for an increased number of examinations in order to improve sensitivity of prenatal diagnosing of CHD. We wish to give our own contribution to the increase of the FE sensitivity. Results: The study involved 1380 pregnant women examined in Fetal cardiology clinic in the University Hospital Centre Zagreb between 1st January 2012 and 1st January 2015. Since some pregnant women were examined two or more times, a total of 2001 examinations were performed, making an average of 600 to 670 examinations performed annually. Most of the indications for FE were determined by obstetricians, while some pregnant women were referred for FE by their rheumatologist, genetic medicine specialist, or physicians of other subspecialties. A few pregnant women were examined at their own request. CHD was diagnosed on FE examination in 14.2% of pregnant women, or rather 196 fetuses. The time window that CHD was most commonly diagnosed in ranged between 22 and 28, or 32 and 36 weeks of gestation (64 + 57 = 121 or 61.7%). Most of the CHDs were detected on the first FE examination, with 27 pregnant women (10.3%) diagnosed on the 2nd or the 3rd examination. Conclusion: The first FE examination should be performed in pregnant women with risk factors for CHD between 22 and 28 weeks of gestation, with a follow-up FE after 32 weeks of gestation. In order to improve the sensitivity of prenatal diagnosing of CHD each pregnant woman should be examined at least twice. Pregnant women with systemic connective tissue disease need to be proposed for FE before 15 weeks of gestation
Učinak pentadekapeptida BPC 157 na cijeljenje rektovaginalnih fistula u štakora [The effect of pentadecapeptide BPC 157 on healing of rectovaginal fistulas in rats]
Get PDFAim. Recto-vaginal fistula is a devastating condition providing more than 99% of patients for surgical treatment. We hypothesized that rectovaginal fistulae may be healed by therapy with stable gastric pentadecapeptide BPC 157, in consistence with its initial clinical application and effect on external fistulas.
Materials and Methods. BPC 157 (10 μg/kg or 10 ng/kg) was given perorally, in drinking water (0.16 μg/ml or 0.16 ng/ml, 12 ml/rat/day) till sacrifice, or alternatively, intraperitoneally, first application at 30 min after surgery, last at 24h before sacrifice. Controls simultaneously received an equivolume of saline (5.0 ml/kg ip) or water only (12 ml/rat/day). The assessment (i.e., rectal and vaginal defect, fistula leakage, defecation through the fistula, adhesions and intestinal obstruction as healing processes) was at day 1, 3, 5, 7, 10, 14 and 21.
Results. Regularly, rectovaginal fistulas exhibited poor healing, with both of the defects persisting, continuous fistula leakage, defecation through the fistula, advanced adhesion formation and intestinal obstruction. By contrast, BPC 157 given perorally or intraperitoneally, in μg and ng regimens rapidly improved the whole presentation, with both rectal and vaginal defects simultaneously ameliorated and eventually healed. The maximal instilled volume was continuously raised till the values of healhty rats were achieved, there were no signs of defecation through the fistula. A counteraction of advanced adhesion formation and intestinal obstruction was achieved. Microscopic improvement was along with macroscopic findings.
Conclusion. BPC 157 effects appear to be suited to induce a full healing of rectovaginal fistulas in rats
Transkateterska implantacija aortalnog zalistka (TAVI) u liječenju bolesnika s teškom aortalnom stenozom: prikaz metode i rezultata u Kliničkome bolničkom centru Zagreb [Transcatheter aortic valve implantation (TAVI) in treatment of patients with sever aortic stenosis: method review and results from Zagreb University Hospital Center]
Get PDFAortic stenosis is the most common valvular heart disease in western countries. Prevalence is increasing with age and is between 2–4% in population aged 65 or above. Despite cardiac surgery, almost third of patients did not undergo surgery due to too high surgical risk and comorbidities. Transcatheter aortic valve implantation (TAVI) is globally approved method for treating sever aortic stenosis in patients whose surgical risk is too high or they are declared as inoperable due to some other medical condition. Using this method, artificial biological valve is implanted, on beating heart, just using catheters at the place of degenerate native valve. In UHC Zagreb TAVI program has started in 2012, and since then, 44 procedures were performed. All procedures, together with periprocedural management were done following recent recommendations and guidelines of the European and American heart societies. This has resulted in very favorable treatment success. In this article, the most important TAVI facts have been highlighted followed by analysis of our TAVI results from the UHC Zagreb
Razvoj instrumenta za procjenu profesionalnih odnosa među bolničkim liječnicima [Development of an instrument for the evaluation of professional interpersonal relationships among hospital physicians]
Get PDFAlthough, physicians’ professional interpersonal relationships single out as crucial (sub)category of medical professionalism and represents a crucial element of physicians’ everyday practice, they haven’t been systematically researched. About their potential importance, with exception of few studies, one can find out from scientific literature which aim is researching professional relationships among healthcare workers in general. Nonetheless, this scientific literature indicates that physician professional interpersonal relationships have a profound impact on health care processes and outcomes in their entirety. Questionnaire named professional interpersonal relationships among physicians (PIR) was developed as a method of evaluating the quality of professional interpersonal relationship among hospital physicians that will be reliable, valid, applicable and adequate for use in everyday practice. PIR is a self-report, five point Likert-type, internet-based questionnaire. Research was conducted through four steps involving qualitative and quantitative methods, with the aim of determining validity, reliability and usability evidence of the proposed questionnaire. Content validity and face validity of instrument were evaluated by first set of focus groups, after witch 52 items were included in next, pilot phase of research. Within the pilot phase of research (March 2016, n=84) 11 items were excluded from further analysis based on discrimination of items analysis and analysis of reliability of questionnaire subscales. Second set of focus groups confirmed findings from preliminary research phases and included additional criterion for establishing criterion validity that consisted of four self-contained items. Final testing phase, validation study (May, June and July 2016, n=445) included physicians working in hospitals in the City of Zagreb. Analysis preformed with additional established criterion excluded further 16 items from quantitative analysis. Further analysis of the final version of PIR questionnaire, which consist of 25 items, reveals sound psychometric properties. Reliability of questionnaire determined by Cronbach alpha coefficient was α=0,95. Explanatory factor analysis yielded two factor solution where the first was named „negative interpersonal relationships“ (which explained 44% variance), and second „shared and unified professional affect“ (which explained 4% variance). Construct (convergent and discriminant) validity of final questionnaire was well established thorough statistically significant correlation between PIR scores and many independent variables as physicians' age, working experience on institutional unit, working experience in medical field, medical speciality, physicians' satisfaction, physicians' subjective assessment of quality of care within institutional unit, turnover intention, workload index and physicians’ self-assessed general health. Results of the study provide robust evidence that PIR questionnaire is reliable, valid and applicable method of evaluating the quality of professional interpersonal relationship among hospital physicians’