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Dvostruko slijepa randomizirana studija o učinkovitosti topičke primjene 2% lidokaina u liječenju simptomatskih hemoroida [Double blinded randomized clinical trial of the efficacy of topical 2% lidocaine for the treatment of symptomatic hemorrhoids]
Get PDFHemorrhoids are the most common ailment affecting the male gender. This condition affects 38.93% of the general population and is even more common in middle aged individuals with higher social-economic status. It is estimated that at least half this population is affected by hemorrhoids at least once in their lifetime. Topical hemorrhoid therapy is the most frequently prescribed first line treatment by the general practitioner and is the most common type of therapy sought by the patient in the beginning stages. There have been no documented randomized clinical studies that observed the quality and success of using perianal lidocaine as treatment and therefore this method is based on empirical findings without any quality clinical proof. We can state that the topical treatment of hemorrhoids is not a medically founded pharmacologic practice, but rather, remains an empirically based treatment without proof of effectiveness. In the American Gastroenterological Association guidelines for diagnosing and treating hemorrhoids, under the topical treatment section, the following is stated: Over the counter topical and suppository products have become more present in the empirical treatment of symptoms associated with hemorrhoids, without any information supporting their use. The goal of this study is to conduct a randomized clinical study on the effectiveness of using local lidocaine compared with a placebo in reducing hemorrhoid symptoms. The main goal is to determine the effectiveness of topical lidocaine use in patients with symptomatic hemorrhoids who, due to this ailment, have changes in the degree of disease and changes/increase in symptoms (pain, itch, bleeding, swelling and comfort are subjective symptoms which we observed and objectified using the validated analogue Corrects scale) The results of this study show that lidocaine, when used as a topical treatment has the identical effect on symptoms using the Corrects scale on days 1,3 and 7 after application as the placebo. If we stratify the individual symptoms such as pail, itch,
swelling, bleeding and comfort, we see that lidocaine when compared with the placebo is not effective in reducing hemorrhoid symptoms. Furthermore, there is no significant difference in the general patients’ health status nor on the subjective decrease in symptoms between the two groups at 1,3 and 7 days after topical application. In both groups there was no noted improvement in the degree of disease and therefore we can conclude that neither lidocaine nor the placebo can influence the morphologic changes in hemorrhoid tissue
HLA-DPB1 matching in unrelated hematopoietic stem cell transplantation program contributes to a higher incidence of disease relapse
Get PDFThe impact of patient/donor matching for HLA-A, -B, -C, -DRB1 and -DQB1 genes in hematopoietic stem cell transplantation (HSCT) is well-recognized, but typing for additional genes, such as HLA-DPB1, is still controversial. Based on defined T-cell epitope (TCE) groups, all HLA-DPB1 mismatches can be classified as permissive or non-permissive. In this retrospective study we analysed 82 patient-matched unrelated donor (MUD) pairs who underwent HSCT, and explored the impact of HLA-DPB1 matches, permissive and non-permissive mismatches on transplantation outcomes. Patient-MUD pairs matched for HLA-DPB1 alleles in univariate analysis were associated with a significantly higher incidence of disease relapse compared to pairs who were permissive/non-permissive HLA-DPB1 mismatched according to the TCE3 and TCE4 algorithms (P=0.025 and P=0.026, respectively), although the significance was lost in multivariate analysis. The analysis did not reveal any significant influence of HLA-DPB1 alleles on overall survival (OS), non-relapse mortality (NRM) or graft-versus-host disease (GvHD) incidence. In conclusion, our study presents evidence that HLA-DPB1 matching influenced the relapse rate in patients after HSCT so the HLA-DPB1 alleles should be implemented in the MUD search algorithm as a transplantation determinant
Fludarabin, ciklofosfamid i rituksimab (FCR) u liječenju bolesnika s kroničnom limfocitnom leukemijom (KLL): iskustvo Kliničkoga bolničkog centra Zagreb [Fludarabine, cyclophosphamide and rituximab (FCR) in the treatment of chronic lymphocytic leukemia (CLL): University Hospital Centre Zagreb experience]
Get PDFIn clinical trials the combination of fludarabine, cyclophosphamide and rituximab (FCR) demonstrated superior results and became the gold standard for first-line treatment of fit patients with chronic lymphocytic leukemia (CLL). The aim of this study was to evaluate the efficacy, toxicity and feasibility of this protocol in everyday clinical practice. We retrospectively analyzed the outcomes of 43 CLL patients treated at the Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb. The dosing of rituximab differed from that in clinical trials, we administered 375mg/m2 of rituximab per cycle, in previously untreated patients for eight and in relapsed/refractory patients for six cycles. The response rate was 95% with 83% of complete remissions. Twenty–nine patients received FCR as a front–line therapy; three-year overall and progression–free survival were 90% and 80%, respectively. In relapsed/refractory disease three–year overall and progression–free survival were 86% and 62%, respectively. Severe neutropenias occurred in 46% and serious infections in 9% of patients. According to these results, the toxicity profile and treatment outcomes in everyday routine clinical practice are similar to those reported in clinical trials
Klinička važnost izražaja metiltransferaze EZH2 i demetilaze histona H3 JMJD3 u karcinomima pločastih stanica hipofarinksa [Clinical Significance of Methyltransferase EZH2 and Demethylase JMJD3 Expression in Malignant Hypopharyngeal Tumors]
Get PDFHypopharyngeal carcinomas account for 10% of all head and neck tumors. The highest incidence of this tumor is recorded in older population, in which it is commonly presented in an advanced stage. It has been known that these tumors contain multiple genetic abnormalities. This research was focused on investigating the relevance of expression of two epigenetic modulators with antagonistic functions on H3K27, EZH2 and JMJD3, in a setting of a clinical features of the tumor and survival in a cochort of 68 patients. Both, EZH2 and JMJD3, were explored at the level of mRNA and protein. The expression of p53 was determined at the protein level by immunohistochemistry, joined with analyses at the level of genomic DNA (loss of heterozygosity). Kaplan Maier method was used for analysis of overall survival in relation to standard clinical data (age, size of the tumor, presence of lymph node metastases, tumor grade) and expression of the target proteins (EZH2, JMJD3 and p53). The difference between survival curves was tested with Gehan-Wilcoxon test. The 2 test was used for determine whether there is a significant difference between the expected frequencies related to standard clinical features of the tumor. Multivariate analysis based on recursive partitioning was presented as the hazard ratio. The most important clinical parameters for survival of this patient cohort are age and the lymph node status. Although not shown as independent prognostic factors for survival, the high expression of JMJD3 and p53 was significantly associated with the tumor size (JMJD3) and the status of lymph nodes (p53), in univariate analysis. An unexpected phenomenon has been presented in a high proportion of samples, by discovery of unchanged EZH2 expression when tumor and non-tumor tissues were compared. At the same time, JMJD3 was significantly increased in the tumor tissue (when compared to non-tumorous tissue). On a protein level, EZH2 expression decreases the hazard ratio in a subgroup of patients younger than 56,5 years with affected lymph nodes (cN2/cN3) (hazard ratio 0,54 (EZH21-3) vs 1,59 (EZH2 0), in relation to the whole cohort). This discovery profiles EZH2 as the third factor (after the age and lymph node involvement) involved in determination of the hazard ratio for these patients
Epidemiološki modeli programa prevencije, dijagnostike i liječenja melanoma
Get PDFMelanoma is a malignant tumor of the skin and it counts for less than 5% of all skin cancers. The incidence of melanoma is growing all over the world, also in Croatia. Due to the increase in the incidence of melanoma it is important to assess the economic impact and the cost of diagnosis and treatment of melanoma. The diagnosis of cutaneous melanoma at an early stage can save lives, reduce treatment costs and generate substantial savings.
In the present study we have examined the epidemiological and pharmacoeconomic characteristics of patients with skin melanonom in Croatia in 5-year periods, taking into account different strategies of prevention and treatment. In addition to the number of patients, deaths and costs, DALYs are calculated according to the methodology of the World Health Organization. For the purposes of modeling, the Markov model is used to estimate the costs and epidemiological burden of disease specific to melanoma in the 5-year period.
The aim of the research included the analysis of prevention strategies for early detection of melanoma, the cost of treatment and diagnosis of melanoma in Croatia and comparison to the potential prevention programs in the national program in the upcoming five-year periods. Epidemiological models and models of economic costs melanoma are made, estimation of total costs and costs per patient, the cost structure to the stages of the disease and recommendations for potential diversion of healthcare budget.
The results show that there is a significant difference in the incidence of melanoma by stages in period without screening period and in the period during the program "Euromelanoma", but there is no statistically significant difference in mortality. It has been shown that the program "Euromelanoma" is a very cost-effective intervention, and ICER is € 385.6 / DALY. The average cost per patient is lowest with screening of high risk population (935 €; 95% CI 906-963 €), and the largest with screening of entire population over 50 years (2 281 €; 95% CI 2078-2484 €). In comparison with the program "Euromelanoma" with implementation of the screening of the risk population 2 273 DALYs can be avoided and despite significantly higher costs resulting from the high cost of vemurafenib, screening of risk populations is very cost-effective intervention (ICER = 5 516 €/ DALY). Screening of risk population is the dominant strategy compared to screening of the entire population older than 50 years
Evaluation of nurses' workload in intensive care unit of a tertiary care university hospital in relation to the patients' severity of illness: a prospective study
Get PDFBACKGROUNDS:
Costs of intensive care reach up to 30% of the hospital budget with workforce expenses being substantial. Determining proper nurse-patient ratio is necessary for optimizing patients' health related outcomes and hospitals' cost effective functioning. -----
OBJECTIVES:
To evaluate nurses' workload using Nine Equivalents of Nursing Manpower Use Score and Nursing Activities Score scoring systems while assessing correlation between both scores and the severity of illness measured by Simplified Acute Physiology Score II. -----
DESIGN:
A Prospective study SETTINGS: Cardiac Surgery Intensive Care Unit of the Clinical Hospital Centre Rijeka, Croatia, from October 2014 to February 2015. This Intensive Care Unit has 3 beds that can be expanded upon need. -----
PARTICIPANTS:
The study included 99 patients treated at this Unit during the study's period. The scores were obtained by 6 nurses, working in 12h shifts. -----
METHODS:
Measurements were obtained for each patient 24h after admission and subsequently twice a day, at the end of the day shift (7pm) and at the end of the night shift (7 am). The necessary data were obtained from the patient's medical records. -----
RESULTS:
Nursing Activities Score showed significantly higher number of nurses are required for one 12h shift (Z=3.76, p<0.001). Higher scores were obtained on day shifts vs. night shifts. (Nursing Manpower Use Score, z=3.25, p<0.001; Nursing Activities Score, z=4.16, p<0.001). When comparing Nursing Activities Score and Nursing Manpower Use Score during the week, we calculated higher required number of nurses on weekdays than on weekends and holidays, (Nursing Manpower Use Score, p<0.001; Nursing Activities Score, p<0.001). Correlation analysis of Nursing Activities Score and Nursing Manpower Use Score with Simplified Acute Physiology Score II has shown that Nursing Manpower Use Score positively associated with severity of disease, while Nursing Activities Score shows no association. -----
CONCLUSION:
Both scores can be used to estimate required number of nurses in 12-h shifts, although Nursing Activities Score seems more suitable for units with prolonged length of stay, while Nursing Manpower Use Score appears better for units with shorter duration of stay (up to four days). Higher workload measured by Nursing Manpower Use Score scale can be predicted with higher Simplified Acute Physiology Score II. However, with low Simplified Acute Physiology Score II scores it cannot be assumed that the nursing workload will also be low. Further research is needed to determine the best tool to asses nursing workload in intensive care units
Kirurško liječenje preponske kile: ambulantno ili bolnički [Inguinal hernioplasty: day surgery or hospital surgery procedure]
Get PDFInguinal hernia repair is a surgical procedure that can be done in inpatient or one-day surgery. Adequate patient selection is not a simple task. There are more than several selection criteria, but the main objective is a patient safety. This study analyzes the patient selection criteria and compares safety in the manner of postoperative complications between the two groups of patients. There were 590 patients who underwent surgical repair of inguinal hernia at the University Hospital Centre Zagreb in 2015. 226 (38.3%) of them were treated in one-day surgery, and 364 (61.7%) were treated at the main Surgical department; 69 of those had an emergent presentation. Most patients of child age (0–18) were treated at the inpatient department. Patients in the age groups between 19 and 39 years, as well as those between 35 and 49 were dominantly managed at the Department of one-day surgery. Those patients were mainly ASA I and ASA II (only three of them were ASA III), while hospitalized patients were mostly ASA II (52.2%). In the hospitalized, inpatient group, frequency of ASA I was 24%, ASA II 21% and ASA IV 3%. The greatest number of one-day surgery patients underwent surgery under local anesthesia (68%). In contrast, only 8% of the inpatient group had a surgery under local anesthesia. The percentage of patients with postoperative wound infection was 2%, and the incidence of pain after surgery was 8%. The results didn’t statistically differ between the groups. The recurrence rate was slightly more frequent in the inpatient group. Hematomas and seromas had the same incidence pattern; they were rarely present and without differences between the groups. 7 of 226 ambulatory patients (3%) were hospitalized. The main causes for three of them were nausea, weakness and hypotension; two patients had tachycardia and stenocardia, one patient had neurasthenia, and also one had scrotal hematoma. The hernia repair in both groups was associated with low postoperative complications, low recurrence rate, and low percentage of unplanned hospital admissions. Therefore it is considered that both groups were treated in a safe manner and patient selection was adequate
Novi ultrazvučni dijagnostički indeks u procjeni sindroma karpalnoga kanala [Novel ultrasound diagnostic index in confirmation of carpal tunnel syndrome]
Get PDFINTRODUCTION: Ultrasound (US) is becoming an increasingly widespread complementary method in
evaluation of carpal tunnel syndrome (CTS) in a routine clinical practice. Although a large number of
studies have been done in order to find an optimal US parameter, to our knowledge, a possibility of
constructing a complex US parameter with potentially improved diagnostic value has not yet been
adressed. The aim of this research was to construct such a parameter and to compare it to previously
used US parameters to assess its potential diagnostical advantage.
METHODS AND PATIENTS: Eighty eight patients with CTS and 78 asymptomatic participants were
enrolled in the study. All participants went through clinical, neurophysiologic and ultrasound
examination. During US examination, median nerve (MN) was measured on 4 anatomical levels. Twolevel
parameters were derived from individual measures. Also, a multicomponent index was constructed
via regression analysis and diagnostical values of all US parameters were calculated by using ROC curves
and AUC values.
RESULTS: Among the simple US parameters CSA-I, CIR-I and CSA-O had the best AUCs (0.969, 0.958 i
0.934; p < 0.001), sensitivity (89,8%, 90,9% i 84,1%; p < 0.001) and specificity (96,2%, 91% i 88,5%; p <
0.001). Analysis of two-level parameters resulted in highest AUC for IOM (0.984; p < 0.001) with very
good sensitivity and excellent specificity (100%, p < 0.001). Complex, regression-based ultrasound index
yielded marginaly higher AUC (0.989; p < 0.001) compared to previously mentioned parameters. CONCLUSION: Mean transcarpal CSA (IOM) is a simple and a reliable parameter in confirmation of CTS.
Complex multicomponent regression-based index (UDICTS) provided in our sample even better
diagnostical characteristics compared to IOM. However, it is overly complicated to acquire and timeconsuming,
thus making the IOM an optimal US parameter in routine CTS confirmation
Smjernice za dijagnozu, liječenje i praćenje bolesnika oboljelih od raka pluća nemalih stanica [Guidelines for diagnosis, treatment and monitoring patients with non-small cell lung cancer]
Get PDFLung cancer is the most common male cancer, and one of the most common female cancers. Non-small cell lung cancers account for 85% of lung cancers. Due to the aggressiveness of the disease and bad prognosis if it is not diagnosed early, it is important to define and implement standardized approach for diagnostics, treatment and monitoring of these patients. Treatment modalities include surgery, chemotherapy, radiotherapy, targeted biologic therapy and immunotherapy according to the stage, specific tumour histological subtype and patient condition
Giant low-grade primary myofibroblastic sarcoma of the posterior chest wall
Get PDFPrimary myofibroblastic sarcoma is an extremely rare, highly malignant neoplasm, and only few cases had been reported in the literature worldwide. In the present study, we report an unusual case of a low-grade myofibroblastic sarcoma located in the posterior chest wall with intrathoracic propagation and discuss its clinical and pathological features