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Systemic Inflammatory Markers as Predictors of Postoperative Complications and Survival in Patients With Advanced Head and Neck Squamous Cell Carcinoma Undergoing Free-Flap Reconstruction
No full textPurpose: The aim of this study was to determine the prognostic value of systemic inflammatory indices as factors for postoperative complications and survival in patients with advanced stages of p16-negative head and neck squamous cell carcinoma undergoing free-flap reconstruction.
Methods: This was a retrospective cohort study. The primary predictor variables were inflammatory markers such as neutrophil, lymphocyte, monocyte, and platelet count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, lymphocyte-monocyte ratio, derived NLR, systemic immuneinflammatory index, and systemic inflammatory marker index (SIM). Multivariate regression analyses were used to measure the associations between systemic inflammatory indices and overall and diseasefree survival as a primary outcome and occurrence of postoperative complications as a secondary outcome measure.
Results: The sample was composed of 69 male (76.67%) and 21 female (23.33%) patients, with an average age of 61.15 9.79 years. The median follow-up time was 24 months, and 73 of 91 (66.43%) patients were alive during the median follow-up. Overall disease survival correlated with systemic immune-inflammation (P = .022, cutoff >1,005.3, sensitivity 67.1%, and specificity 70.6%) and SIM (P = .0001, cutoff >4.05, sensitivity 90.4%, and specificity 41.2%), preoperative platelets (P = .036, cutoff 4.05, sensitivity 91.3%, and specificity 38.1%), NLR (P = .031, cutoff >13.2, sensitivity 56.9%, and specificity 60%), and preoperative platelets (P = .006, cutoff 2.3) and postoperative lymphocytes (P = .009, DF 1, c2 test 6.756, cutoff <1) correlated with occurrence of complications.
Conclusions: Inflammatory indices as measures of inflammation-related systemic dysfunction may be associated with adverse survival in patients with head and neck squamous cell carcinoma and occurrence of postoperative complications and with specific cutoff values
Comprehensive cardiac evaluation reveals no increase in ventricular arrhythmias in patients on chronic ibrutinib therapy: a study of KroHem, the Croatian cooperative group for hematologic diseases
No full textProlonged treatment with ibrutinib had no significant impact on number of VPBs or SPBs. Our study suggests that ibrutinib does not significantly increase the propensity to develop dangerous cardiac arrhythmias in patients who do not have clinically important structural heart disease or arrhythmias prior to treatment start and stresses the importance of hypertension control in this group of patients
Guidelines for diagnosis and treatment of patients with neck pain – Part 1
No full textVratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralješnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Ovaj prvi dio odnosi se na dijagnostiku, a drugi njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke postupke. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. This part (Part 1) relates to diagnosis, while the complementary part (Part 2) relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community
Vorzeitiger Blasensprung in der 16. Schwangerschaftswoche: Bericht über einen erfolgreichen Schwangerschaftsverlauf und Literaturübersicht
No full textPrelabor rupture of the fetal membranes (premature rupture of membranes, PROM) before or at the limit of fetal viability is condition associated with significant and serious pediatric morbidity and mortality. It is a rare problem, with an estimated incidence between 0.1 and 0.7%. Management of this condition is one of the most challenging clinical situations in obstetrics. We report the case of a pregnant woman presenting at 16 weeks gestation with ruptured membranes. The course of pregnancy was further complicated by complete placenta previa. Expectant management was undertaken, with term delivery and successful outcome of pregnancy. Expectant management is a reasonable approach in properly selected patients. Better understanding of the mechanisms of spontaneous membrane resealing is needed in order to improve poor outcomes. More published data and evidence are necessary to standardize treatment options for this rare condition.Vorzeitiger Blasensprung („premature rupture of membranes“, PROM) vor oder an der Grenze der fetalen Lebensfähigkeit ist ein Zustand, der mit einer signifikanten und schwerwiegenden kindlichen Morbidität und Mortalität zusammenhängt. Es handelt sich um ein seltenes Ereignis mit einer geschätzten Inzidenz zwischen 0,1 und 0,7 %. Die Behandlung dieser Erkrankung ist eine der schwierigsten klinischen Situationen in der Geburtshilfe. Die Autoren berichten vom Fall einer Schwangeren, die in der 16. Schwangerschaftswoche mit vorzeitigem Blasensprung vorstellig wurde. Als weitere Komplikation lag eine vollständige Placenta praevia vor. Das abwartende Management führte letztlich zu termingerechter Entbindung und erfolgreichem Ausgang der Schwangerschaft. Bei ausgewählten Patienten ist eine abwartende Behandlung ein adäquater Ansatz. Es ist notwendig, den Mechanismus des spontanen Verschlusses der fetalen Membranen besser zu verstehen, um gute Ergebnisse zu erzielen. Weitere Daten und Studien sind erforderlich, um die Behandlungsoptionen für diesen seltenen Zustand zu standardisieren
Utjecaj straha bolesnika od infekcije COVID-19 na neurološku službu u Kliničkom bolničkom centru Sestre Milosrdnice tijekom izbijanja epidemije COVID -19
No full textIncreasing evidence suggests that patients with medical emergencies are avoiding the emergency department because of fear of coronavirus disease 2019 (COVID-19) infection, leading to increased morbidity and mortality due to other diseases. In order to analyse the impact of patient’s fear of COVID-19 on the admittance rate of stroke patients and severity of neurological diseases, we compared the stroke admittance rate, numbers of thrombectomies and thrombolysis and hospitalization refusal rate during the time period from March 1st until June 30th 2020 in temporal relationship with the rising numbers of COVID-19 cases in Croatia. We assessed the patients’ neurologic disease severity measured by ventilation time and mortality rate in the same time period. We compared the data with the data obtained from the same time period in 2019. We observed dramatically decreased presentation in Neurologic Emergency Department due to stroke and neurologic disease in 2020 compared to 2019, increased refused hospitalization rate and similar stroke treatment rate despite bigger catchment area. Greater neurologic disease severity with almost 40% increased ventilation time and double mortality rate during the same time was observed. During the outbreak of COVID-19 epidemic, fear of infection had significant impact on neurologic service leading to decreased presentation to NED, resulting in increased stroke or neurologic disease-related morbidity and mortality.Sve je više dokaza koji upućuje na to da bolesnici s hitnim medicinskim stanjima izbjegavaju hitnu službu zbog straha od infekcije koronavirusom 2019 (COVID-19), što dovodi do povećanog morbiditeta i smrtnosti od drugih bolesti. Kako bismo analizirali utjecaj straha bolesnika od infekcije COVID-19 na stopu prihvata bolesnika s moždanim udarom i težinu neuroloških bolesti, uspoređivali smo stopu prihvata za moždani udar, broj trombektomija i trombolize i stopu odbijanja hospitalizacije tijekom razdoblja od 1. ožujka. do 30. lipnja 2020. u vremenskom odnosu s rastućim brojem slučajeva COVID-19 u Hrvatskoj. Procijenili smo težinu neuroloških bolesti mjerom vremena mehaničke ventilacije i stopom smrtnosti u istom razdoblju. Usporedili smo podatke s podacima dobivenim iz istog kalendarskog vremenskog razdoblja u 2019. godini. Primijetili smo dramatično smanjenje broja pregleda u Hitnoj neurološkoj ambulanti zbog moždanog udara i neuroloških bolesti 2020. godine u odnosu na 2019. godinu, povećanu stopu odbijene hospitalizacije i sličnu stopu liječenja moždanog udara usprkos većem pripadajućem teritoriju. Uočili smo
veću težinu neuroloških bolesnika mjerenu gotovo 40% povećanim vremenom mehaničke ventilacije i udvostručenom stopom smrtnosti u istom vremenskom razdoblju. Tijekom izbijanja epidemije COVID-19, strah od infekcije imao je značajan utjecaj na neurološku službu, što je dovelo do smanjene prezentacije neuroloških bolesnika u neurološkoj hitnoj službi, a rezultiralo je povećanim morbiditetom i smrtnošću zbog moždanog udara ili drugih neuroloških bolesti
Acute stroke treatment during COVID-19 pandemic "lockdown" period – Croatian experience
No full textBackground and purpose: Inevitable lockdown scenario during the first wave of COVID-19 pandemic led to different approaches of medical care system worldwide. During this period, health care services faced the problem of time, place and human resources management. However, in spite of redirecting health forces to fight this new and unknown virus in all countries, the need of routine treatment of all the other emergencies according to the guidelines remained present. The aim of our study was to analyse the acute stroke care in Croatia during first wave of Covid pandemic.
Materials and methods: In order to achieve the rate of stroke patients admitted to hospital care in dedicated hospital stroke units and centers, we have gathered the data from four Croatian University Hospitals. We analyzed the number of hospitalized stroke patients from 1th of February to 1th of May 2020 and the proportions of patients treated with recanalization therapy.
Results: Our results showed a slight decrease of number of all neurological patients who arrived to the Emergency Unit. In 2019 recanalization therapy was given to 158 patients (19%) vs 177 (26%) in 2020. Thrombolysis alone was given to 72 (9%) of patients in 2019 and to 68 (10%) of patients in 2020, while thrombectomy (with or without thrombolysis) has been performed to 86 (10%) vs 109 (16%) patients in 2019 and 2020 respectively.
Conclusion: In conclusion, we did not notice less severe stroke patients or lower level of stroke care in University Hospitals
Associations of aspirin, statins and metformin with lung cancer risk and related mortality
No full textCardiovascular diseases (CVDs), including ischaemic heart disease and cerebrovascular disease, are the leading cause of death in both sexes worldwide, followed by cancer. Most CVDs can be prevented by addressing behavioural risk factors, such as tobacco smoking, unhealthy diets, obesity, physical inactivity and harmful use of alcohol. Individuals with CVDs or those at high cardiovascular risk due to the presence of one or more risk factors (e.g. arterial hypertension, diabetes, hyperlipidaemia and obesity) require early detection and management. Counselling and medicines should be offered, as appropriate. These shared metabolic and behavioural risk factors are causatively linked to the development of heart disease, stroke, cancer, diabetes and respiratory diseases. Lung cancer is, by far, the most common cause of cancer-related death worldwide. Given that lung cancer patients may initially present with cardiovascular and/or metabolic comorbidities at the time of cancer diagnosis, questions have been raised as to whether long-term use of combined medications to treat these diseases affects the incidence and mortality of lung cancer patients on a population-based level. Established oral therapies are currently the cornerstone of prevention of cardiovascular and metabolic diseases, and include: 1) the anti-thrombotic agent acetylsalicylic acid (also known as aspirin) for reducing CVD morbidity and mortality among survivors of myocardial infarction and stroke; 2) the glucose-lowering agent metformin as the first-line therapeutic agent for type 2 diabetes (T2D); and 3) the lipid-lowering statins as effective drugs for reducing the risk of myocardial infarction, ischaemic stroke, and development of peripheral arterial disease. The impact of these medications on the present management of cardiovascular and metabolic diseases is emphasised by the fact that these agents are in the World Health Organization model list of essential medicines. Over the past few decades, these groups of drugs have commonly been prescribed together as a measure of chemoprevention given the close interconnection between cardiovascular disease, diabetes and dyslipidaemia. Nevertheless, in the literature to date, both observational and
randomised controlled trials (RCTs) have merely assessed the individual potential effects of each of these three types of agents, without taking into account their combined effect, dose–response relationship or time-dependent exposure. The study to be discussed here by Kang et al. has shed some light on the latter
Dobroćudni multicistični peritonejski mezoteliom s oponašanjem ginekološke patologije
No full textBenign multicystic peritoneal mesothelioma is a rare pathology that arises from the abdominal peritoneum. It has an affinity to develop on the surfaces of pelvic viscera. It predominantly occurs in women of reproductive age. The most used form of treatment is complete surgical removal. We report a case of a 21-year-old female patient who presented with unclear diffuse abdominal pain. Transvaginal ultrasound and magnetic resonance imaging of the abdomen and pelvis revealed multiple functional cysts in the projection of the right and left ovary and free fluid in the pouch of Douglas. Laparoscopy was performed and multicystic tumor with thin, smooth walls, filled with clear serous content was found in lesser pelvis spreading to the left paracolic region and under the spleen. The multicystic mass was removed. Histologic examination revealed cystic formations filled with mucous content and formed from connective tissue outside and single row epithelium-mesothelium inside. Definitive diagnosis was benign multicystic mesothelioma of the abdominal peritoneum. The patient was well at one year follow-up.Dobroćudni multicistični peritonejski mezoteliom je rijetka bolest koja nastaje iz abdominalnog peritoneja. Obično se razvija na zdjeličnom peritoneju, najčešće u žena generativne dobi. Najuobičajeniji način liječenja je potpuno kirurško uklanjanje. Prikazujemo slučaj 21-godišnje djevojke koja nam se javila s nejasnom difuznom boli. Transvaginalni ultrazvuk i magnetna rezonanca trbuha i zdjelice otkrili su višestruke funkcionalne ciste u projekciji desnog i lijevog jajnika i u Douglasovu prostoru. Učinjena je laparoskopija i nađen je multicistični tumor s tankim glatkim zidovima ispunjenim bistrom seroznom tekućinom u maloj zdjelici, koji se širio u lijevu parakoličnu regiju i ispod slezene. Multicistična masa je uklonjena. Patohistološka analiza je otkrila cistične formacije ispunjene sluzi i građene od vezivnog tkiva izvana i jednorednim epitelmezotelom iznutra. Konačna dijagnoza je bila dobroćudni multicistični mezoteliom abdominalnog peritoneja. Bolesnica se redovito kontrolira bez znakova bolesti
Novelties in etiopathogenesis, diagnosis and treatment of patients with lumbar intevrertebral disc degeneration
No full textKrižobolja je jedan od najčešćih uzroka fizičke nesposobnosti, čije je najčešće izvorište degeneracija intervertebralnog diska. Nemogućnost točnog utvrđivanja potjecišta boli jest ograničavajući čimbenik u učinkovitijoj prevenciji i liječenju. Nova saznanja, napose u područjima genetike i analize proteina primjenom spektrometrije masa, bacaju novo svjetlo u razumijevanju etiopatogeneze degenerativne bolesti diska. Novim slikovnim metodama kao što je CEST magnetska rezonancija ili ADC magnetska rezonancija mogu se detektirati rane degenerativne promjene. Napredak je ostvaren glede razjašnjenja uloge fizičkog opterećenja, kao i tipa vježbi koje mogu imati utjecaj kako na razvoj tako i na liječenje bolesnika s degenerativnim promjenama diska. Na kraju, značajan napredak je ostvaren u kirurškom liječenju tih bolesnika, s naglaskom na minimalno invazivne tehnike. Ostali kirurški modaliteti liječenja su pokazali napredak koji ohrabruje, kao što su totalna zamjena diska i liječenje mezenhimalnim matičnim stanicama. Uz navedeno, i ostale novosti u dijagnostici i liječenju degenerativne bolesti vertebralnog diska raspravljene su u ovom članku.Low-back pain is one of the most common causes of physical disability, most often originating from intervertebral disc degeneration. Lack of pinpointing the exact source of pain is the limiting factor in more efficient prevention and treatment. New findings, especially in the fields of genetics and mass spectometry based protein analysis, shed a new light to the understanding of etiopathogenesis of disc degenerative disease. New imaging methods like chemical exchange saturation transfer (CEST)MRI or apparent diffusion coefficient (ADC)MRI can detect early degenerative changes. Advances have been made regarding elucidating the role of physical load, as well as the type of exercise that can have an impact on the development and treatment of patients with degenerative disc disease. Finally, a significant progress has been made in the surgical treatment ecouraging of these patients, with an emphasis on minimally invasive techniques. Other surgical modalities have also shown improvement, like total disc replacement and mesenchymal stem cells treatments. These, and other novelties in the diagnosis and treatment of degenerative disc disease of lumbar spine are discussed in this article
Association between periodontitis and liver disease
No full textRecent clinical and scientific evidence confirms the negative impact of long-term periodontitis on the clinical course and progression of various liver diseases. Periodontitis is a chronic, slow-progressing infectious disease of the tooth supporting tissues caused mainly by the gram-negative bacteria Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola and Tannerella forsythia. These specific pathogens can be easily translocated from oral cavity to the intestine. Disruption of the intestine microbiota composition by orally derived periodontal pathogenic bacteria has recently been suggested to be a causal mechanism between periodontitis and liver disease. Furthermore, both diseases have the ability to induce an inflammatory response and lead to the creation of inflammatory mediators through which they may influence each other.
Recent epidemiologic studies have demonstrated that individuals with liver cirrhosis have considerably poorer periodontal clinical parameters than those without cirrhosis. Periodontal therapy in cirrhosis patients favorably modulates oral and gut microbiome, the course of systemic inflammation, cirrhosis prognostic factors, and cognitive function. Therefore, future clinical researches should be focused on detailed examination of the biological mechanisms, strength and direction of the association between advanced liver disease and periodontitis