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Utjecaj primjene deksametazona u spinalnoj anesteziji kod prijeloma bedrene kosti [Influence of dexamethasone administration in spinal anesthesia for femur fracture]
Get PDFProximal femur fractures are the most common cause of emergency admission to hospital with
high postoperative morbidity. The hypothesis is that one single shot of dexamethasone with levobupivacaine in spinal
anesthesia reduces postoperative pain and cognitive disturbances. The study included 60 patients with proximal femur fracture, ASA status 2 and 3 who were
randomized into two groups. DLSA group received 8 mg of dexamethasone and 12.5 mg of
0.5% levobupivacaine intrathecally. LSA group received only levobupivacaine. The
postoperative cognitive disturbance was evaluated with CAM-ICU score scale, the pain
intensity was measured with VAS scale and cortisol and glucose samples were taken before and
after surgery. Surgical correction was made in 63% of patients in 48 hours after admission.
Ephedrine was used in LSA group, P=0,044. We found shorter hospitalization in DLSA group
(P=0,045), shorter duration from surgery to discharge (P=0,044), there was lower occurrence
of delirium and POCD (P=0,043), longer analgesia (P<0,001) and lower cortisol levels. Regression model in DLSA group showed less occurrence of postoperative cognitive
disturbance for 7,67 times. Conclusion: Intrathecal administration of dexamethasone in spinal anesthesia reduces stress
response by lowering cortisol levels, pain, occurrence of POCD with better rehabilitation
quality and shorter hospitalization without affecting bleeding
Procjena tumora jetre kvantitativnom ultrazvučnom elastografijom [Assessment of liver tumours using quantitative sonoelastography]
Get PDFReal-time two-dimensional shear-wave elastography (RT-2D-SWE) is a quantitative ultrasound elastography method for measuring tissue stiffness. The aim of this study was to analyse elastographic characteristics of the most common liver tumours and to evaluate the potential of RT-2D-SWE to differentiate benign and malignant focal liver lesions (FLL). Consecutive patients with ultrasonically detected FLL were included and elastographic evaluation of FLL and non-infiltrated liver was undertaken. The nature of the FLL was defined through a standard diagnostic workup, including contrast enhanced multi-slice CT and MRI and cytology/histology, as applicable. We analysed 159 FLL, 53 in each group (HCCs, metastases and haemangioma). Malignant lesions were stiffer (p<0.001) with higher variability of intralesional stiffness (p=0.001). The best performing cut-off for lesion stiffness was 22,04 kPa (sensitivity 78.3%, specificity 94,34, positive predictive value (PPV) 96,5% negative predictive value (NPV) 68,5%.). Predication of malignancy based on logistic regression and artificial neural networks was excellent (AUROC for regression and 0.986 for ANN). In conclusion, according to results of the study RT-2D-SWE appears to be very accurate for the differentiation of malignant and benign FLL based on tumour elasticity parameters and stiffness of liver parenchyma easily measurable during ultrasound examination with elastography
Usporedba femtosekundnoga lasera i mehaničkih mikrokeratoma pri laserskoj disekciji rožnice [Comparison of femtosecond laser and mechanical microkeratomes for laser in situ keratomileusis]
Get PDFLaser in situ keratomileusis (LASIK) is the most commonly performed elective
surgical procedure today. Creation of the corneal flap is considered as the most
critical part of the surgery. Currently, flaps can be created with mechanical
microkeratomes or femtosecond lasers. So far, there is no definitive evidence in the
literature claiming one technology is better than the other.
In this study visual acuity, refractive results, ocular higher order aberrations, contrast
sensitivity, characteristics of the tear film, thickness and morphology of the flap,
incidence of intraoperative and postoperative complications and patients’ satisfaction
were compared between two mechanical microkeratomes (group I – Moria M2, group
II – Moria SBK One Use Plus) and two femtosecond lasers (group III – Ziemer Femto
LDV, group IV – Technolas 520F). Respondents were included in the study from April
2011. till December 2012. One hundred and fifty four respondents were enrolled with
myopia from -0,50 D to -7,50 D and up to 2,50 D of astigmatism with best corrected
visual acuity of 0,00 LogMAR. Follow up was one year. All excimer laser ablations
were performed on Schwind Amaris 750S excimer laser. In groups I, II and III 50
patients was enrolled. Group IV was cancelled after experiencing technical difficulties
during flap creation. Target was to achieve emmetropia in all cases. At first day, first
week and then after 1,3,6 and 12 months after the surgery uncorrected (UDVA) and
best corrected distance visual acuity (CDVA), spherical and cylindrical refractive
results, spherical equivalent (SE), magnitude of high order aberrations (namely,
coma, spherical aberration (SA) and trefoil) and contrast sensitivity (CS) were
measured. Schirmer test and Tear Break Up Time (TBUT) test were measured after
1 week, 1, 3, 6 and 12 months after the surgery. Central flap thickness was
measured intraoperatively, while flap profile on two axes (90° and 180°) and 5
measuring points was measured with anterior optical coherence tomography at 1
day, 1 week and 1 month after the surgery. All intraoperative and postoperative
complications were noted. Respondents were given standardized patients’
satisfaction questionnaire after refractive surgery (National Eye Institute Refractive Error Quality of Life – 42 Instrument – NEI RQL–42). All collected data were analyzed
within each group and between the groups.
Before the surgery the groups did not differ in UDVA, CDVA, spherical and cylindrical
refractive results, coma, SA and TBUT values. Statistically significant differences
were found in amount of ocular trefoil (p=0,020), CS (p<0,001) and Schirmer test
(p=0,005). Statistically significant improvement in UDVA was observed in all three
groups (p<0,001). One year after the surgery, the highest values of UDVA were
found in group III. There was no difference in CDVA before and after the surgery in
all three groups (p>0,05). Significant reduction in spherical and cylindrical refractive
error together with SE was observed in all three groups (p<0,001). Significant
differences of spherical refractive error one year after the surgery was found between
group I and group II (p=0,008), between group I and group III (p=0,013) but not
between group II and group III (p=0,689). There was no difference in cylindrical
refractive error between the groups throughout the whole follow up period (p>0,05). A
statistically significant difference was found between group I and group III for SE at
one year postop (p=0,008). The lowest SE value was found in group III and the
highest in group I. All ocular higher order aberrations increased in magnitude after
surgery (p<0,001) and tended to reduce in time. Values of ocular coma reached
preoperative levels 3 months after the surgery (p>0,05) in all three groups. In groups
II and III values of ocular coma were significantly lower at one year postop in
comparison to preoperative values (p<0,001). Values of ocular trefoil reached the
preoperative levels at one month postop (p>0,05) and at the end of the follow up
values were significantly lower in comparison to preoperative levels (p<0,001).
Postoperative SA values reached preoperative levels at one week (group I –
p=0,151), one month (group III – p=0,056) and three months (p=0,541) after the
surgery. Decrease in SA values were noted up until the end of the follow up but
without statistical significance (p>0,05). Initial postoperative deterioration of contrast
sensitivity was observed in all three groups after the surgery (p<0,001). CS values
reached preoperative levels at 3 months after the surgery (p>0,05). Statistically
significant improvement in CS values were observed at the end of the follow up in
comparison to preoperative levels (p<0,001). In all three groups values of Schirmer
test significantly decreased after the surgery (p<0,001). In groups I and III Schirmer
test values reached preoperative levels at 1 year after the surgery (p=0,656,
p=0,121) while in group II preoperative levels were reached at 6 months (p=0,079) and at one year after the surgery statistically significant improvement was observed
(p=0,021). TBUT values significantly decreased after the surgery in all three groups
(p<0,001), and they reached preoperative levels at one year after the surgery
(p=0,807, p=676, p=0,007). There was no statistically significant difference in TBUT
values between the groups at one year after the surgery (p=0,060). Central flap
thickness was 110,91±15,79 μm (80-164 μm) in group I, 98,08±13,33 μm (65-136
μm) in group II and 103,52±13,89 μm (66-138 μm) in group III. Anterior optical
coherence tomography revealed meniscus shaped flap in all three groups on both
axes (90° and 180°). The least variability in flap thickness was observed in group III
(±6 μm). Intraoperative complications were low in all three groups (groups I and II
2%, group III 3%). In group I 1% of postoperative complications was noted, in group II
2%, and there were no postoperative complications in group III. Patients’ satisfaction
was high in all three groups. The difference between groups was noticed in
categories “Distance vision” (p=0,022), “Other symptoms” (p=0,019) and “Physical
appearance” (p=0,011). The lowest satisfaction rate was noticed in group I.
All three methods produced good and acceptable clinical results. Linear
microkeratomes (Moria SBK One Use Plus) had similar performances as Ziemer
Femto LDV femtosecond laser in all measured parameters, while rotatory
microkeratome (Moria M2) had slightly lower performances in some of the measured
parameters
Opportunities and challenges in rheumatology research in Central Europe
Get PDFThe Central European Congress of Rheumatology (CECR) has been organized by seven Central European countries: Austria, Croatia, Czech Republic, Hungary, Poland, Slovakia, and Slovenia. These countries have lots of similarities, but also differences, with respect to rheumatology research. In this paper, based on questionnaires, we wish to demonstrate achievements and difficulties in rheumatology research performed in our region
Delayed care and mortality among women and men with myocardial infarction
Get PDFBACKGROUND:
Women with ST-segment-elevation myocardial infarction (STEMI) have higher mortality rates than men. We investigated whether sex-related differences in timely access to care among STEMI patients may be a factor associated with excess risk of early mortality in women. -----
METHODS AND RESULTS:
We identified 6022 STEMI patients who had information on time of symptom onset to time of hospital presentation at 41 hospitals participating in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry (NCT01218776) from October 2010 through April 2016. Patients were stratified into time-delay cohorts. We estimated the 30-day risk of all-cause mortality in each cohort. Despite similar delays in seeking care, the overall time from symptom onset to hospital presentation was longer for women than men (median: 270 minutes [range: 130-776] versus 240 minutes [range: 120-600]). After adjustment for baseline variables, female sex was independently associated with greater risk of 30-day mortality (odds ratio: 1.58; 95% confidence interval, 1.27-1.97). Sex differences in mortality following STEMI were no longer observed for patients having delays from symptom onset to hospital presentation of ≤1 hour (odds ratio: 0.77; 95% confidence interval, 0.29-2.02). -----
CONCLUSIONS:
Sex difference in mortality following STEMI persists and appears to be driven by prehospital delays in hospital presentation. Women appear to be more vulnerable to prolonged untreated ischemia
Lipid lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel
Get PDFScoring systems for peptic ulcer bleeding: which one to use?
Get PDFAIM: To compare the Glasgow-Blatchford score (GBS), Rockall score (RS) and Baylor bleeding score (BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. METHODS:
Between January 2008 and December 2013, 1012 consecutive patients admitted with peptic ulcer bleeding (PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores (RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics (AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were evaluated. RESULTS:
PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome (AUROC 0.82 vs 0.67 vs 0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality (AUROC 0.84 vs 0.57 vs 0.64), rebleeding (AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion (AUROC 0.83 vs 0.63 vs 0.58) and surgical intervention (0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome (AUROC 0.82 vs 0.69, respectively). CONCLUSION:
The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one 'perfect score' and we suggest that these two tests be used concomitantly
Lack of CD4 + T cell percent decrease in alemtuzumab-treated multiple sclerosis patients with persistent relapses
Get PDFAlemtuzumab, a highly effective treatment for relapsing remitting multiple sclerosis (RRMS), induces lymphopenia especially of CD4+ T cells. Here, we report the atypical CD4+ T population behaviour of two patients with persistent disease activity despite repeated alemtuzumab treatments. Whereas lymphocytes count decreased and fluctuated accordingly to alemtuzumab administration, their CD4+ cell percentage was not or just mildly affected and was slightly below the lowest normal limit already before alemtuzumab. These cases anticipate further studies aimed to investigate whether the evaluation of the CD4+ cell percentage could represent a helpful tool to address the individual clinical response to alemtuzumab
Translating recent results from the Cardiovascular Outcomes Trials into clinical practice: recommendations from the Central and Eastern European Diabetes Expert Group (CEEDEG)
Get PDFAIMS:
These recommendations aim to improve care for patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk in Central and Eastern Europe. Cardiovascular disease (CVD) and/or chronic kidney disease (CKD) are major interdependent comorbidities in patients with T2D, accounting for 50% of mortality. Following recent CV outcomes trial (CVOT) results, including those from EMPA-REG OUTCOME®, LEADER®, SUSTAIN™-6 and, most recently, the CANVAS study, it is essential to develop regional expert consensus recommendations to aid physicians in interpreting these newest data to clinical practice. -----
METHODS:
The Central and Eastern European Diabetes Expert Group (CEEDEG) followed a Delphi method to develop treatment algorithms to aid physicians in the clinical management of patients with T2D at high CV risk. -----
RESULTS:
In light of the latest CVOT results, and in particular the EMPA-REG OUTCOME® and LEADER® trials, the diagnosis, assessment, treatment choice and monitoring of patients with T2D and established CVD and/or CKD have been considered together with existing guidelines and presented in two reference algorithms. In addition, adherence, special prescribing considerations and a proposed multidisciplinary management approach have been discussed and are presented with the proposed algorithms. -----
CONCLUSIONS:
The latest available high-level evidence on glucose-lowering drugs has enabled CEEDEG to develop practical consensus recommendations for patients with established CVD and/or CKD. These recommendations represent an update to international and country-level guidelines used for these patients, with the aim of providing a resource not only to endocrinologists, but to cardiologists, nephrologists and primary care physicians in the region
Myocardial bridging as one of the causes of atypical chest pain in young women
Get PDFINTRODUCTION:
Myocardial bridging is congenital anomaly which usually has benign prognosis but there are also reports suggesting that it can be associated with ischemic clinical syndromes presenting with chest pain. Coronary computed tomography angiography is a well-established method for detecting myocardial bridging. However, clinical significance of this anomaly still remains unclear. ----- METHODS:
We studied 977 patients who presented with recurrent typical or atypical chest pain in outpatient clinic. All patients have undergone detailed clinical examination, ECG stress testing and coronary computed tomography angiography. ----- RESULTS:
Highest positive prediction for having myocardial bridging was for patients presenting with atypical chest pain with negative ECG stress test and who were younger women. ----- CONCLUSION:
Coronary computed tomography angiography may be preferable method for evaluation of chest pain in younger women presenting with atypical chest pain