Repository of the Sestre milosrdnice University Hospital Center
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Legionnaires' disease in Croatian hospitals
No full textBolnički stečena pneumonija vodeći je uzrok smrtnosti među pacijentima s bolničkom infekcijom (smrtnost veća od 50% među pacijentima u intenzivnoj skrbi).Hospital-acquired pneumonia is the leading cause of mortality among patients with hospital-acquired infections (mortality greater than 50% among patients in intensive care)
Effects of Occupational Stress on the Activation of Hemostatic and Inflammatory System
No full textA 24-hour shift is one of the major stressors for physicians because, apart from causing fatigue and circadian rhythm disorders, it often requires making vital decisions for patients within a short time frame. It is known that workplace stress leads to the activation of the coagulation system, which can result in imbalance of the coagulation and fibrinolysis system. The state of stress can also generate proinflammatory mediators. The aim of this study was to examine the effect of 24-hour shift on global coagulation tests of D-dimers and fibrinolysis, and on C-reactive protein (CRP) as an acute inflammatory agent and proatherosclerotic factor. Sixty physicians (residents) aged 25-35 participated in this study (30 participants in the experimental group and 30 participants in the control group). In experimental group, blood samples were collected on three occasions: shortly before 24-hour shift, twelve hours after the shift had begun, and at the end of the shift. Blood samples were collected from control group participants at the same time points. The results showed that there was no statistically significant difference in the values of D-dimer and fibrinolysis between the experimental and control groups. CRP values were statistically significantly higher in the experimental (1.57, 1.49 and 1.50) than in the control group (0.79, 0.75 and 0.84) on all three measurements (p=0.024, p=0.020 and p=0.030, respectively). These results confirmed the existence of proinflammatory changes in the endothelium of blood vessels, which is a factor associated with accelerated atherosclerosis
Razvoj banke koštanog tkiva u Sveučilišnoj kliničkoj bolnici Mostar
No full textBone tissue banks are necessary for collection, production, testing, packaging, storage and delivery of bone transplants. Bone tissue bank is a link between the donor and the recipient by which the donation becomes a medium of health improvement for both the donor and the recipient. At the Department of Orthopedics, Mostar University Clinical Hospital, about 200 total hip replacements are performed per year. Most patients undergoing total hip replacement surgery (90%) have been diagnosed with osteoarthritis, and they are suitable donors, having in mind their age and comorbidities. In the same Department, around 50 procedures that require bone transplants are performed per year. A team of highly competent surgeons are working on an intensive process of adaptation oriented to quality improvement and intensification of the activity, both with the goal of meeting the standards of excellence in orthopedic surgery. The presence of a bone tissue bank has a favorable impact on the quality of health care owing to bone transplant availability, as well as on the scientific role of a highly specialized institution that examines the properties of bone tissue.Banke koštanog tkiva su odgovorne za skupljanje, proizvodnju, ispitivanje, pakiranje, skladištenje i isporuku koštanih transplantata. Banka koštanog tkiva premosnica je od donora k primatelju prilikom koje se donacija pretače u sredstvo za poboljšanje zdravstvenog stanja kako primatelja tako i davatelja. Na Klinici za ortopediju Sveučilišne kliničke bolnice Mostar na godinu se ugradi oko 200 totalnih proteza kuka. Većini bolesnika kojima se ugrađuje totalna proteza kuka (90%) identificirana je dijagnoza osteoartritisa te su pogodni davatelji, s tim da se u obzir uzimaju komorbiditeti i životna dob. Na godinu se na Klinici izvodi oko 50 različitih operacija za koje trebaju koštani presatci. Tim visoko kompetentnih kirurga bavi se intenzivnim procesom adaptacije koji je orijentiran poboljšanju kvalitete i jačanju aktivnosti s ciljem zadovoljenja standarda izvrsnosti u ortopedskoj kirurgiji. Prisutnost ovakve koštane banke učinkovito utječe na kvalitetu skrbi kako zbog brže dostupnosti implantata tako i zbog znanstvene uloge visoko specificirane ustanove koja bazično istražuje svojstva koštanog tkiva
Genetic and lifestyle predictors of ischemic stroke severity and outcome
No full textBackground: Different models that include clinical variables and blood markers have been investigated to predict acute ischemic stroke treatment course and recovery.
Aim: The aim of the study was to investigate associations between lipid levels, lifestyle factors, hemostatic (F5, F2, SERPINE1, F13A1, and FGB), and atherogenic (APOA5 and ACE) gene variants and acute ischemic stroke (AIS) severity. Materials and methods This study included 250 patients with AIS in which F5, F2, SERPINE1, F13A1, FGB, APOA5, and ACE genotypes were determined. Total cholesterol (TC), high-density cholesterol, low-density cholesterol, and triglycerides concentrations were measured within 24 h of the AIS onset. Examination of the neurological deficit was done using National Institutes of Health Stroke Scale/Score (NIHSS).
Results: APOA5 genotype [TC + CC] was more frequent (P = 0.026) in patients with the NIHSS score ≥ 21. Univariate regression analysis has shown that triglycerides (OR 0.55, 95% CI 0.34–0.91; P = 0.019), obesity (0.28, 95% CI 0.10–0.73; P = 0.010), age (OR 1.08, 95% CI 1.04–1.13; P < 0.001), and APOA5 genotype (TC + CC) (OR 2.40, 95% CI 1.10–5.25; P = 0.034) are significantly associated with a severe stroke. When all variables were included in model age (OR 1.06, 95% CI 1.01–1.11; P = 0.018), obesity (OR 0.25, 95% CI 0.08–0.77; P = 0.016) and APOA5 genotype (TC + CC) (OR 3.26, 95% CI 1.29–8.23; P = 0.012) remained significant for the risk of severe AIS.
Conclusion: APOA5 genotype (TC + CC), age, and obesity could be used as prognostic risk factors for a very severe stroke
(NIHSS ≥ 21)
Prognostička vrijednost ekspresije CD44 i neovaskularizacije određene endoglinom (CD05) u bolesnika s glioblastomom
No full textGlioblastoma multiforme (GBM) is the most common and most aggressive malignant primary brain tumor in humans. Clinically useful molecular markers that help predict response to therapy and prognosis are still rare. The research was conducted in 55 patients with GBM, 26 (47.3%) women and 29 (52.7%) men, mean age 62.58 years. On immunohistochemical analysis, primary antibody to CD44 (dilution 1:50) and primary antibody to endoglin (CD105) (dilution 1:250) were used to evaluate neovascularization. Statistical analysis showed negative correlation between CD44 and survival (p=0.023) (higher expression of CD44 was correlated with shorter survival), but there was no correlation between neovascularization determined by CD105 in GBM and patient survival. Thus, significant individual predictors of longer survival were lower expression of CD44 (p=0.004), higher Karnofsky score (p=0.045), and female gender (p=0.017). The results obtained suggested the possible role of CD44 in the progression and tumor neovascularization of GBM.Glioblastom multiforme (GBM) je najčešći i najagresivniji maligni primarni tumor mozga u ljudi. Postoje tek rijetki molekularni biljezi koji su klinički korisni te pomažu u predviđanju odgovora na terapiju i u prognozi bolesti. Istraživanje je provedeno kod 55 bolesnika s GBM, 26 (47,3%) žena i 29 (52,7%) muškaraca, prosječne dobi od 62,58 godina. U imunohistokemijskoj analizi je za procjenu neovaskularizacije korišteno primarno antitijelo prema CD44 (razrjeđenje 1:50) i primarno antitijelo prema endoglinu (CD105) (razrjeđenje 1:250). Statistička analiza je pokazala negativnu korelaciju između CD44 i preživljenja (p=0,023) (veća ekspresija CD44 je korelirala s kraćim preživlje-njem), ali nije bilo korelacije između neovaskularizacije (određene putem CD105) kod GBM i preživljenja ovih bolesnika. Tako su značajni pojedinačni prediktori dužeg preživljenja bili niža ekspresija CD44 (p=0,004), veći Karnofskyjev zbir (p=0,045) i ženski spol (p=0,017). Dobiveni rezultati ukazuju na moguću ulogu CD44 u progresiji i tumorskoj neovaskularizaciji kod GBM
Type II Hypopharyngeal Defect Reconstruction - a Single Institution Experience
No full textThere are several options for hypopharyngeal reconstruction depending on defect size. Reconstructive options include primary closure, local flaps, regional axial flaps or regional intestinal flaps, and free flap transfer with skin or intestinal free flaps. The preferred method of reconstruction should minimize early postoperative complications that prolong hospital stay and/or become life threatening, ensure early restoration of function and decrease donor site morbidity. The purpose of this study was to evaluate functional outcomes of different flap reconstruction methods in type II hypopharyngeal defects. In this non-randomized retrospective cohort study, data on 31 (27 male and four female) patients were collected over a 10-year period of single institution type II hypopharyngeal defect reconstructions. The following measures of functional outcome were extracted from patient medical histories: postoperative complications (flap failure, fistula formation, donor site related complications), hospital stay in days and swallowing function after 14 days, 1 month and 6 months. There were nine patients in the radial forearm free flap (RFFF) reconstruction group, seven in the jejunum reconstruction group, and 15 in the gastric tube reconstruction group. In the RFFF group, three patients experienced flap failure; in the jejunal transfer group, no donor site morbidity was observed; whereas three patients from the gastric tube reconstruction group had minor abdominal skin wound dehiscence. Out of the 3 different reconstructive methods, RFFF was most likely to fail. The mean duration of hospital stay was 22.6 days, being shortest in the RFFF group. There were no significant differences in early postoperative swallowing function among the groups. The choice of flap used for hypopharynx reconstruction should be driven by donor site factors and functional outcomes. When assessing type II hypopharyngeal defect reconstruction results, the findings of this study suggest that free jejunal flaps and gastric tubes offer superior functional results in comparison with RFFFs
Balon za sazrijevanje cerviksa maternice u predindukciji porođaja - jednocentrična studija
No full textCervical ripening can be promoted in many ways, but mechanical methods are among the oldest. Like all other methods, this one also has its pros and cons. Disadvantages compared to pharmacological methods include some maternal discomfort upon manipulation of the cervix, a theoretical increase in the risk of maternal and neonatal infection from the introduction of a foreign body, potential disruption of a low-lying placenta, and increase in the need of oxytocin induction of labor. The aim of the study was to evaluate the effect of using cervical ripening balloon in preinduction on the mode of delivery. This was a longitudinal, cohort, intervention, non-randomized one center study. Inclusion criteria were term pregnancies with gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Preinduction of labor was performed in term pregnancies at Sestre milosrdnice University Hospital Center. Results in the first 150 women having undergone labor preinduction with cervical ripening balloon were included. Two-sided p values <0.05 were considered significant. Statistical analysis was done using SPSS Version 20.0. The study included 150 women; one woman was excluded from further analyses due to conversion of fetal presentation (head to breech). Indications for labor preinduction were as follows: gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Women with normal vaginal delivery (96/149) had lower rates of gestational diabetes and oligohydramnios and used epidural analgesia more frequently. Women with dystocia (32/53) had a significantly longer labor duration and higher neonatal birth weight. In multivariate analysis, multiparity, greater cervical dilatation after balloon removal and use of epidural analgesia were associated with a decreased risk of cesarean section, while the presence of gestational diabetes and oligohydramnios was associated with an increased risk of cesarean section. We found this preinduction method safe and efficient, with a potential to increase the rate of vaginal deliveries.Sazrijevanje cerviksa maternice može se poticati na nekoliko načina. Najstarije metode su mehaničke metode koje imaju svojih prednosti i nedostataka. Nedostaci u usporedbi s farmakološkim metodama uključuju određenu majčinsku nelagodu pri manipulaciji cerviksom maternice, povećanje rizika od majčine i neonatalne infekcije zbog unošenja stranog tijela, mogućnost ozljede posteljice niskog sijela i povećanu potrebu za uporabom oksitocina u porođaju. Cilj istraživanja bio je procijeniti učinak korištenja balona na sazrijevanje cerviksa maternice u predindukciji porođaja. Provedena je longitudinalna, kohortna, intervencijska, ne-randomizirana studija. Kriteriji za uključivanje bili su terminske trudnoće s gestacijskim dijabetesom, oligohidramnijem, intrauterinim zastojem u fetalnom rastu, gestacijskom hipertenzijom/preeklampsijom i trudnoća nakon navršenih 41 tjedna trudnoće. Studiju smo provodili kod žena s terminskim trudnoćama u Kliničkom bolničkom centru Sestara milosrdnica. Prikazani su rezultati u prvih 150 trudnica kod kojih je provedena predindukcija porođaja cervikalnim balonom. Vrijednosti p<0,05 smatrale su se značajnima. Statistička analiza provedena je pomoću SPSS Version 20.0. Studija je obuhvatila 150 trudnica, a jedna žena je bila isključena iz daljnjih analiza zbog konverzije fetalnog stava (glave u zadak). Indikacije za predindukciju porođaja su bile: gestacijski dijabetes, oligohidramnij, intrauterini zastoj fetalnog rasta, gestacijska hipertenzija/preeklampsija i trudnoća nakon navršenih 41 tjedna trudnoće. Trudnice koje su rodile vaginalno (96/149) imale su manju učestalost gestacijskog dijabetesa i oligohidramnija i kod njih je češće korištena epiduralna analgezija. Trudnice bez napredovanja porođaja (32/53) imale su značajno duže trajanje porođaja i veću tjelesnu težinu novorođenčeta. U multivarijatnoj analizi su multiparitet, veća dilatacija cerviksa nakon uklanjanja balona i primjena epiduralne analgezije bili povezani sa smanjenim rizikom carskog reza, dok je prisutnost gestacijskog dijabetesa i oligohidramnija bila povezana s povećanim rizikom carskog reza. Smatramo da je ova predindukcijska metoda sigurna, učinkovita i može dovesti do povećanja broja vaginalnih porođaja
Comparison of normal saline and balanced crystalloid intravenous therapy during neurosurgery
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Dietary habits in Croatian future healthcare providers
No full textDuring the last few decades, Croatia has experienced a rapid socio-cultural development that resulted in westernized eating habits, which, progressively leads to increase in obesity and type 2 diabetes occurrence among youth, especially adolescents and students