Veterinary medicine - Repository of PHD, master's thesis
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Proton pump inhibitors use prior to COVID-19 hospitalization is associated with higher C lostridioides difficile infection rate
No full textBackground: There are uncertainties regarding associations of prior proton pump inhibitor (PPI) use with susceptibility for COVID-19 and risks associated with SARS-CoV-2 infection. We aimed to evaluate the associations of prior PPI use with outcomes in hospitalized patients with COVID-19.
Research design and methods: We have retrospectively evaluated a total of 5959 consecutively hospitalized patients with COVID-19 from a tertiary-level institution in the period 3/2020-6/2021. Associations of prior PPI use with outcomes of in-hospital mortality, mechanical ventilation, intensive care unit stay, venous thromboembolism, arterial thrombosis, major bleeding, bacteremia, and Clostridioides difficile infection (C. diff.) were evaluated in entire and case-matched cohorts.
Results: Among 5959 evaluated patients, there were 1967 (33%) PPI users. In an entire cohort, prior PPI use was associated with higher in-hospital mortality and higher occurrence of C. diff. Association of prior PPI use with mortality diminished, whereas association with C. diff. persisted after multivariable adjustments. In a matched cohort, prior PPI use was associated only with higher risk of C. diff. but not other outcomes in line with multivariable analysis.
Conclusions: Although prior PPI use might not have a significant impact on clinical course and mortality of SARS-CoV-2 infection, it may predispose patients to the development of complications like higher occurrence of C. diff. and thus substantially impact the course of treatment
The impact of different white matter segments damage on neurodevelopmental and electroencephalografic features in premature children
No full textCilj našeg istraživanja bio je ispitati povezanost lezija različitih segmenata bijele tvari s maturacijskim, patološkim elektroencefalografskim obilježjima i neurološkim ishodom u nedonošene djece kroz period praćenja od 24 mjeseci. U istraživanje je uključeno 61 nedonošče gestacijske dobi od 24 do 34 tjedana.
Temeljem rezultata istraživanja možemo reči da opsežnost lezija bijele tvari na MR mozga dobro i točno diskriminira skupine djece s psihomotornim zaostajanjem prema Bayley-III procjeni. Oštećenja segmenta I, II i III bijele tvari pozitivno korelira sa stupnjem neurološkog odstupanja u dobi od 12 mjeseci života. Također, lezije bijele tvari u području frontalnog i parijatalnog režnja velikog mozga te parijetalnog crossroads-a prediktor su neurološkog odstupanja u dobi od 12 odnosno 24 mjeseci života dok je stanjenje korpusa kalozuma povezano je s neurološkim odstupanjem u terminski korigiranoj dobi. Oštećenje parijetalnog
crossroads-a povezano je s oštećenjem motorike, a prošireni subarahnoidalni prostori s kognitivnim poteškoćama i poteškoćama u razvoju jezika i govora. Stupanj lezija bijele tvari na MR mozga bolje diskriminira skupine djece s psihomotornim zaostajanjem u dobi od 2 godine u odnosu na stupanj patološki promjenjenog EEG-a u terminskoj dobi.
Novorođenački epileptički napadaji češće se javljaju u prematurusa sa stanjenjem korpusa kalozuma, a prošireni subarahnoidalni prostori prediktor razvoja epilepsije. Djeca s novorođenačkim epileptičkim napadajima češće imaju poteškoće u kognitivnom i
socioemocionalnom razvoju.
Zaključno možemo reći da je oštećenje različitih segmenata bijele tvari u prijevremeno rođene djece povezano s psihomotornim odstupanjem kao i pojavom epileptičkih napadaja. Stoga, u svrhu poboljšanja kvalitete života te izrazito vulnerabilne skupine ključan je multidisciplinaran pristup, pomno i dugoročno praćenje kao i pravovremeno liječenje.The aim of our study was to examine the association between lesions of different white matter segments with maturational, pathological electroencephalographic features and neurological outcome in premature infants over a follow-up period of 24 months. The study included 61 preterm infants between 24 to 34 gestational weeks.
Based on the results of the study, we can say that the extent of white matter lesions on brain MR well and accurately discriminates groups of children with psychomotor retardation according to the Bayley-III assessment. Damage of white matter segments I, II and III correlates positively with the degree of neurological impairment at 12 months of age. Also,
white matter lesions of frontal and parietal lobes and parietal crossroads are predictor of neurological impairment at 12 and 24 months of age, while thinning of the corpus callosum is associated with neurological impairment at term-corrected age. Lesions of parietal crossroads are associated with impaired motor skills while dilated subarachnoid spaces with cognitive
and language developmental difficulties. The degree of white matter lesions on brain MRI better discriminates groups of children with psychomotor retardation compared to the degree of EEG patology.
Neonatal convulsions are more common in prematures with thinning of the corpus callosum while dilated subarachnoid spaces are predictor of epilepsy. Children with neonatal convulsions are more likely to have difficulties with cognitive and socioemotional development.
Brain ultrasound overestimates pathology of mild degree white matter lesions relative to brain MRI. The highest predictive value for psychomotor retardation have ultrasound findings of brain damage performed in the second week of life and at the term corrected age.
In conclusion, we can say that damage to different segments of white matter in premature infants is associated with psychomotor deviation as well as the occurrence of epileptic seizures. Therefore, in order to improve the quality of life of this highly vulnerable group, a multidisciplinary approach, close and long-term monitoring as well as timely treatment are crucial
Influence of corneal biomechanics on surgically induced astigmatism after cataract surgery in pseudoexfoliative syndrome
No full textKornealna histereza (CH) i kornealni faktor rezistencije (CRF) kornealna su biomehanička svojstva koja mogu utjecati na postoperativni astigmatizam nakon operacije katarakte. Pretpostavlja se da pacijenti s pseudoeksfolijativnim (PEX) sindromom imaju promijenjene, odnosno niže vrijednosti kornealnih biomehaničkih svojstava u odnosu na pacijente bez PEX sindroma. Cilj je ovog istraživanja bio razjasniti ponašanje rožnice i utjecaj njenih biomehaničkih svojstava na postoperativni astigmatizam kod pacijenata s PEX sindromom nakon operacije katarakte.
74 pacijenta (oka) kojima je operirana katarakta u Klinici za očne bolesti KBC-a Zagreb uključena su u ovo prospektivno opservacijsko istraživanje i praćena tijekom 30 dana. Operaciju katarakte je izveo jedan operater metodom fakoemulzifikacije kroz kornealnu inciziju veličine 2,75 mm smještenu na 12 sati. Svim su pacijentima preoperativno i postoperativno 1., 7. i 30. dana učinjeni oftalmološki pregled, mjerenje kornealne biomehanike i snimka kornealne topografije.
Analizom podataka utvrđeno je da pacijenti s PEX sindromom imaju niže vrijednosti CH-a i CRF-a u odnosu na kontrolnu skupinu, no razlika nije bila statistički značajna. Nadalje, pacijenti s PEX sindromom imali su na svim pregledima statistički značajno veći kornealni astigmatizam nego ispitanici kontrolne skupine. Pritom je u obje skupine postoperativni astigmatizam bio statistički značajno veći od preoperativnog astigmatizma.
Utjecaj operacije katarakte na biomehanička svojstva rožnice izraženiji je kod pacijenata s PEX sindromom. U prilog tome govore statistički značajno sniženje CH-a 1. postoperativnog dana i statistički značajno povećanje u razdoblju od 1. do 30. postoperativnog dana, kad su se vrijednosti CH-a vratile na preoperativne razine, dok se CRF nije značajno mijenjao tijekom postoperativnog razdoblja praćenja. U kontrolnoj je skupini došlo do smanjenja CH-a 1. postoperativnog dana uz njegov oporavak na preoperativne vrijednosti 30. dana nakon operacije, no promjene nisu dosegle statističku značajnost. CRF je u kontrolnoj skupini blago porastao 1. postoperativnog dana, nakon čega je nastupilo statistički značajno smanjenje između 1. i 7. postoperativnog dana te je 30. dana nakon operacije CRF ostao nižih vrijednosti u odnosu na preoperativnu razinu, ali se ta razlika također nije pokazala statistički značajnom.
Glavni prediktori postoperativnog astigmatizma 30. dana nakon operacije katarakte kod pacijenata s PEX sindromom utvrđeni regresijskom analizom bili su preoperativna vrijednost CH-a, vrijednost CRF-a 1. postoperativnog dana, preoperativni i rani postoperativni astigmatizam 1. i 7. dana, i preoperativna os astigmatizma, a u kontrolnoj skupini preoperativni i rani postoperativni astigmatizam, te vrijednost CRF-a 1. postoperativnog dana.
Iz utvrđenog proizlazi da biomehanika rožnice utječe na postoperativni astigmatizam samo kod pacijenata s PEX sindromom te da rožnica u ovih pacijenata pokazuje različito ponašanje pod utjecajem operacije katarakte za razliku od pacijenata bez PEX sindroma, no daljnja će istraživanja biti potrebna da bi se dodatno razjasnile točne patogenetske i kliničke promjene u rožnici i poboljšali postoperativni rezultati kod ovih pacijenata.Corneal hysteresis (CH) and corneal resistance factor (CRF) are corneal biomechanical properties that may influence postoperative astigmatism after cataract surgery. It is assumed that patients with pseudoexfoliative (PEX) syndrome have altered, that is, lower values of corneal biomechanical properties compared to patients without PEX syndrome. The aim of this study was to clarify the behavior of the cornea and the influence of corneal biomechanical properties on postoperative astigmatism in patients with PEX syndrome after cataract surgery.
Seventy-four patients (eyes) who underwent cataract surgery at the UHC Zagreb Eye Clinic were included in this prospective observational study and followed for 30 days. Cataract surgery was performed using the phacoemulsification method through a 2.75 mm corneal incision located at 12 o'clock by one surgeon. Preoperatively and postoperatively on the 1st, 7th and 30th day, all patients underwent an ophthalmological examination, measurement of corneal biomechanics and a recording of corneal topography.
Data analysis revealed that patients with PEX syndrome had lower values of CH and CRF compared to the control group, but the difference was not statistically significant. Furthermore, patients with PEX syndrome had statistically significantly higher astigmatism than subjects of the control group at all examinations. In both groups, postoperative astigmatism was statistically significantly higher than preoperative astigmatism.
The impact of cataract surgery on the biomechanical properties of the cornea is more pronounced in patients with PEX syndrome. This is supported by a statistically significant decrease in CH on the 1st postoperative day, and a statistically significant increase from the 1st to the 30th postoperative day, when CH values returned to preoperative levels, while CRF did not change significantly during the postoperative follow-up period. In the control group, there was a decrease in CH on the 1st postoperative day with its recovery to preoperative values on the 30th day after surgery, but the changes did not reach statistical significance. In the control group, CRF increased slightly on the 1st postoperative day, then a statistically significant decrease occurred between the 1st and 7th postoperative days, and on the 30th day after surgery, CRF remained at lower values compared to the preoperative level, but this difference also did not show statistical significance.
The main predictors of postoperative astigmatism on the 30th day after cataract surgery in patients with PEX syndrome determined by regression analysis were the preoperative value of CH, the value of CRF on the 1st postoperative day, preoperative and early, 1st and 7th day, postoperative astigmatism, and preoperative axis of astigmatism, and in the control group preoperative and early postoperative astigmatism and the value of CRF on the 1st postoperative day.
From the findings, it follows that corneal biomechanics affects postoperative astigmatism only in patients with PEX syndrome and that the cornea in these patients shows different behavior under the influence of cataract surgery in contrast to patients without PEX syndrome, but further research will be needed to clarify the exact pathogenetic and clinical changes in the cornea and improve postoperative results in these patients
Adjustments in family medicine practice organization and patient care in Croatia during the COVID-19 pandemic: results from the cross-sectional PRICOV-19 study
No full textCilj: opisati organizaciju zdravstvene skrbi u ordinacijama obiteljske medicine (OM) u Republici Hrvatskoj (RH) za vrijeme pandemije COVID-19 iz perspektive dimenzija kvalitete skrbi (sigurnost, učinkovitost, usmjerenost osobi, pravičnost, pravovremenost i efikasnost). Utvrditi oblike suradnje zdravstvenih djelatnika u ordinacijama OM te ispitati postojanje razlika u pogledu kvalitete skrbi i suradnje zdravstvenih djelatnika s obzirom na smještaj ordinacija.
Ispitanici i metode: Istraživanje je provedeno kao dio međunarodnog presječnog istraživanja PRICOV-19. Podatci su prikupljani anonimnim online anketnim upitnikom na prigodnom uzorku ispitanika obiteljskih liječnika (N=1270) u razdoblju od ožujka do lipnja 2021. godine. U radu je analiziran dio upitnika koji se odnosio na karakteristike liječnika i ordinacije, pokazatelje kvalitete skrbi i suradnju zdravstvenih djelatnika. Rezultati su prikazani parametrima deskriptivne statistike, uz primjenu hi-kvadrat testa za testiranje razlika.
Rezultati: Od 1270 upitnika, 148 je uključeno u statističku obradu (stopa odgovora 11,7%). Ordinacije OM organizirale su rad naručivanjem pacijenata te provodile trijažu prije ulaska pacijenata u ordinaciju (98,4%), primjenjujući protokole (97,3%) te uz podršku liječnika u situaciji kada je ne-liječničko osoblje provodilo trijažu (100,0%). Ograničenja vezana uz prostor ili infrastrukturu ordinacije te potrebu prilagodbe prostora u budućnosti navelo je 67,6% odnosno 71,0% ordinacija. Većina ordinacija (66,1%) aktivno je kontaktirala vulnerabilne skupine pacijenata. Obiteljski liječnici u ruralnom području češće su aktivno kontaktirali pacijente koji bi mogli odgoditi zdravstvenu skrb (P=0,028). Od 9,6% do 28,2% ordinacija zabilježilo je neki oblik neželjenog događaja povezan s odgađanjem skrbi za pacijente. U slučaju bolesti osoblja, 69,4% ordinacija je moglo računati na pomoć susjednih ordinacija.
Zaključak: Ordinacije obiteljske medicine u RH učinile su značajne organizacijske prilagodbe kako bi osigurale pružanje kvalitetne zdravstvene skrbi za vrijeme pandemije COVID-19. Potrebna su daljnja istraživanja kako bi se unaprijedile spoznaje o tome koja obilježja prakse i zdravstvenog sustava doprinose poboljšanju kvalitete zdravstvene skrbi u uvjetima pandemije zarazne bolesti u OM.Aim: To describe the organization of care in family medicine (FM) practices in Croatia during the COVID-19 pandemic from the perspective of six dimensions of care quality (equity, patient-centeredness, safety, effectiveness, timeliness, and efficiency) and practice collaboration, to investigate the differences in terms of quality of care and practice collaboration between urban and rural practices.
Patients and methods: This study was a part of the international cross-sectional PRICOV-19 study. A translated version of the online questionnaire was distributed to a convenient sample of 1270 FM practices in Croatia from March to June 2021. Data on physician and practice characteristics, practice collaboration and six dimensions of quality of care were analyzed. Differences between urban and rural practices were assessed using chi-square test.
Results: A total of 148 questionnaires (response rate 11.7%) was included in the analysis. FM practices used appointment systems and performed triage before patients entered the practice (98.4%), using protocols (97.3%) and providing a family physician (FP) as a backup when non-FP practice staff performed the triage (100.0%). Limitations to the practice building/infrastructure and considering making future adjustements was reported by 67.6% and 71.0% of FM practices, respectively. Most practices (66.1%) actively reached out to vulnerable patients. Family physicians from rural areas more often actively reached out to patients who might postpone health care (p=0.028). Some type of patient safety incident related to a delayed care process was reported by 9.6% to 28.2% of the responding FPs. In case of a staff member’s absence due to COVID-19, 69.4% of practices could count on the help from the neighboring FM practices.
Conclusions: Croatian FM practices made important organizational changes to deliver high-quality care during the COVID-19 pandemic. Further research is needed to understand which practice and healthcare system characteristics contribute to the improvement of health care quality in primary care during pandemics
Comparing Italian versus European strategies and technologies for respiratory care in NICU: results of a survey of the Union of European Neonatal and Perinatal Societies (UENPS) and the Italian Society of Neonatology (SIN)
No full textBackground: Our survey aimed to compare information on respiratory care in Neonatal Intensive Care Units (NICUs) in Italy and in the European and Mediterranean region.
Methods: Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units in the domain of respiratory care was sent to directors/heads of 528 NICUs.
Results: The response rate was 75% (397/528 units). The median number of NICU beds and the admission rate per unit/year of preterm infants < 1500 g was significantly lower in Italy compared with Europe (p < 0.001). In most Italian Delivery Rooms (DR) full resuscitation is given from 22 to 23 weeks gestational age, while 21.0% of the European units initiate from 24 weeks. Initial FiO2 is set as per American Academy of Pediatrics guidelines in 81.1% of Italian units compared to 30.9% of the European ones (p < 0.001). DR surfactant is less often given through Less-Invasive-Surfactant-Administration (LISA) in Italy (53.4% vs. 76.2% of units, p < 0.03). Volume-targeted, synchronized intermittent positive-pressure ventilation (IPPV) is the preferred invasive mechanical ventilation (MV) mode to treat acute RDS across the surveyed units, however 22.9% % of Italian centers vs. 6.8% of the European ones use HFOV as first choice (p < 0.001). During HFOV, 78% of Italian NICUs set mean airway pressure (MAP) following a lung recruitment procedure compared to 41% of the centers in Europe (p < 0.001). In the NICUs, most of the non-invasive (NIV) modes used are nasal CPAP and nasal IPPV. For infants on NIV, LISA strategy is used in 25.6% of Italian vs. 60.0% of European units (p < 0.001). 70% of surveyed units use a brand caffeine. Inhaled steroids are used in 42.3% of Italian vs. 65.4% of European NICUs (p < 0.001).
Conclusions: respiratory support strategies among the surveyed Italian and European NICUs are quite dissimilar in some areas, particularly where high-quality evidence is lacking. We believe that hese data will allow stakeholders to make comparisons and to identify opportunities for improvement
Differences in sex and age response to single pill combination based antihypertensive therapy reflecting in blood pressure and arterial stiffness
No full textObjective: There are noticeable sex differences in the treatment response to antihypertensives, with limited data on the response to single pill combinations. The aim of the PRECIOUS trial was to assess the treatment response to perindopril/amlodipine and perindopril/amlodipine/indapamide dual and triple single-pill combination in men and women.
Methods: Four hundred and forty adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial. Based on the previous antihypertensive therapy, patients were assigned to either perindopril/amlodipine 4/5 mg or perindopril/amlodipine/indapamide 4/5/1.25 mg, with the initial dose up-titrated in 4-week intervals in case of uncontrolled blood pressure. An additional analysis was performed for sex- and age-related differences on the blood pressure response and arterial stiffness in men and women aged 35-74 years.
Results: Women achieved better overall blood pressure control in all age groups, except for the 35-44 age group. Women presented higher average 24 h aortic augmentation indexes than men, but had more pronounced decreasing trends. The pulse wave velocity was only age-dependent, with reductions slightly greater in women. Both the aortic augmentation index and pulse wave velocity were significantly decreased in all groups compared to baseline.
Conclusions: The results of the PRECIOUS trial contribute significant data to the expanding body of evidence on sex differences in hypertension, including the aspect of age-related changes during the life course of women. The differences between same-aged men and women tend to be smaller with advancing age, but with a greater treatment response in women in all age groups for all observed blood pressure parameters and arterial stiffness
The role of vitamin D in the pathogenesis of inflammatory arthritis
No full textUvod. Unatrag nekoliko desetljeća, brojna su istraživanja ukazala na mogući značaj vitamina D u patogenezi i aktivnosti reumatoidnog artritisa i seronegativnih spondiloartritisa. U ovome radu smo ispitali taj značaj.
Ciljevi rada. Ispitati razine serumskog vitamina D, utvrditi udio bolesnika koji imaju nedovoljnu razinu vitamina D, procijeniti postoje li razlike u razinama vitamina D između muškaraca i žena te istražiti mogući odnos između razina vitamina D i dobi kod zdravih osoba, bolesnika s osteoartritisom te bolesnika s upalnim artritisima u trenutku postavljanja dijagnoze, kao i procijeniti rizik za niske razine serumskog vitamina D.
Metode. Ovo retrospektivno istraživanje temelji se na analizi već prikupljenih podataka iz medicinske dokumentacije 103 pacijenata. Podaci su prikupljeni iz povijesti bolesti pacijenata koji su u razdoblju od kolovoza 2023. do svibnja 2025. godine po prvi put dijagnosticirani s osteoartritisom, reumatodinim artritisom, aksijalnim spondiloartritisom, psorijatičnim artritisom i nediferenciranim/perifernim spondiloartritisom u Reumatološkoj ambulanti Klinike za unutarnje bolesti Kliničke bolnice Sveti Duh.
Rezultati. U ovome je istraživanju pokazano kako nema statistički značajne razlike u koncentracijama serumskog vitamina D između ispitanika oboljelih od osteoartritisa, upalnih artritisa i kontrolne skupine. Isto tako, nije ustanovljena značajna razlika u riziku za nedovoljnu razinu serumskog vitamina D. Daljnja analiza podataka je pokazala da 40% oboljelih od upalnih artritisa ima nedostatnu razinu serumskog vitamina D, što je manje negoli u kontrolnoj skupini, gdje je taj udio iznosio 47%. Među oboljelima, najveći udio ispitanika s nedostatnom razinom serumskog vitamina D zabilježen je u skupini s psorijatičnim artritisom, i to u iznosu od 66,7% Analiza razlika prema spolu pokazala je da muškarci imaju nešto više prosječne razine vitamina D u usporedbi sa ženama. Korelacija između dobi i spola nije bila statistički značajna.
Zaključak. Rezultati ovog istraživanja nisu potvrdili hipotezu, niti su u skladu s ostalim istraživanjima. Jedan od doprinosa je da bi uzorak ispitanika trebao biti veći te da bi valjalo obratiti pozornost na okolišne čimbenike, poput prehrane te sezonske i zemljopisne varijacije. Buduća bi se istraživanja trebala usmjeriti ka utvrđivanju uzročno-posljedične veze.Introduction. Over the past few decades, numerous studies have indicated the possible importance of vitamin D in the pathogenesis of rheumatoid arthritis and seronegative spondyloarthritis. In this paper, we examined this importance.
Objectives. To examine serum vitamin D levels, determine the proportion of patients with insufficient vitamin D levels, assess whether there are differences in vitamin D levels between men and women, and investigate the possible relationship between vitamin D levels and age in healthy individuals, patients with osteoarthritis, and patients with inflammatory arthritis at the time of diagnosis, as well as assess the risk for low serum vitamin D levels.
Methods. This retrospective study is based on the analysis of previously collected data from the medical records of 103 patients. Data were collected from the medical histories of patients who were first diagnosed with osteoarthritis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, and undifferentiated/peripheral spondyloarthritis in the Rheumatology Outpatient Department of the Clinic of Internal Medicine, Sveti Duh Clinical Hospital, between August 2023 and May 2025.
Results. This study showed that there was no statistically significant difference in serum vitamin D concentrations between subjects with osteoarthritis, inflammatory arthritis, and the control group. Similarly, no significant difference was found in the risk for insufficient serum vitamin D levels. Further analysis of the data showed that 40% of subjects with inflammatory arthritis had insufficient serum vitamin D levels, which was lower than in the control group, where this proportion was 47%. Among patients, the highest proportion of subjects with insufficient serum vitamin D levels was recorded in the psoriatic arthritis group, at 66.7%. Analysis of differences by gender showed that men had slightly higher average vitamin D levels compared to women. The correlation between age and gender was not statistically significant.
Conclusion. The results of this study did not confirm the hypothesis, nor are they consistent with other studies. One contribution is that the sample size should be larger and that attention should be paid to environmental factors, such as diet and seasonal and geographical variations. Future research should focus on establishing a cause-and-effect relationship
C-reactive protein as a prognostic factor in acute coronary syndrome
No full textUvod: Upalni procesi igraju ključnu ulogu u razvoju i destabilizaciji aterosklerotskih plakova u akutnom koronarnom sindromu (AKS). C-reaktivni protein (CRP), kao biomarker sistemske upale, sve se češće ističe kao vrijedan prognostički pokazatelj u bolesnika s AKS-om.
Ciljevi rada: Primarni cilj bio je ispitati povezanost vrijednosti CRP-a s razvojem velikih neželjenih kardiovaskularnih događaja (MACE) nakon AKS-a. Sekundarni ciljevi uključivali su usporedbu vrijednosti CRP-a ovisno o prisutnosti komorbiditeta i rizičnih čimbenika.
Materijali i metode: Retrospektivna studija obuhvatila je 121 bolesnika liječenog zbog AKS-a u KBC-u Sestre milosrdnice tijekom razdoblja od devet mjeseci. Prikupljeni su demografski podaci, čimbenici kardiovaskularnog rizika, laboratorijski i angiografski nalazi te klinički ishodi. Vrijednosti CRP-a analizirane su u tri vremenske točke (prijem, 6 i 12 sati nakon perkutane koronarne intervencije, PCI), a klinički ishodi praćeni su telefonskom anketom u vremenu praćenja 3–12 mjeseci nakon AKS-a. Isključeni su bolesnici s aktivnom infekcijom, malignom bolešću, terminalnom bubrežnom bolesti i terminalnom bolešću jetre.
Rezultati: U studiju je uključen 121 bolesnik s AKS-om, od čega 35,5 % sa ST-elevacijskim infarktom miokarda (STEMI) i 64,5 % s akutnim koronarnim sindromom bez ST elevacije (NSTE-AKS). Arterijska hipertenzija bila je značajno češća u NSTE-AKS skupini (p=0,02), dok je CRP 6 sati nakon PCI bio značajno viši u STEMI skupini (p=0,02). 12 sati nakon PCI zabilježen je trend porasta CRP-a u STEMI skupini (p=0,05). U bolesnika sa STEMI-jem i povišenim CRP-om češće su se javljale komplikacije (postinfarktna angina, reinfarkt i srčano popuštanje), dok smrtnost nije zabilježena ni u jednoj skupini.
Zaključak: Ova retrospektivna analiza ukazuje na prognostičku vrijednost CRP-a u akutnom koronarnom sindromu, osobito kod STEMI-ja, gdje su više vrijednosti bile povezane s većim rizikom od MACE-a. Iako u NSTE-AKS-u povezanost nije bila jednako izražena, povišeni CRP i tamo je ukazivao na viši rizik postinfarktne angine. Nalazi podupiru potencijalnu ulogu CRP-a u ranoj identifikaciji visokorizičnih bolesnika, uz potrebu za daljnjim istraživanjima s većim uzorkom i osjetljivijim metodama mjerenja.Introduction: Inflammatory processes play a key role in the development and destabilization of atherosclerotic plaques in acute coronary syndrome (ACS). C-reactive protein (CRP), a biomarker of systemic inflammation, is increasingly recognized as a valuable prognostic indicator in patients with ACS.
Objectives: The primary objective was to examine the association between CRP levels and the development of major adverse cardiovascular events (MACE) following ACS. Secondary objectives included comparing CRP values to the presence of comorbidities and cardiovascular risk factors.
Materials and Methods: This retrospective study included 121 patients treated for ACS at University Hospital Centre Sestre Milosrdnice over nine months. Demographic data, cardiovascular risk factors, laboratory and angiographic findings, and clinical outcomes were collected. CRP levels were analyzed at three time points (on admission, 6 hours, and 12 hours after percutaneous coronary intervention (PCI)), and clinical outcomes were assessed by telephone follow-up between 3 and 12 months after the ACS event. Patients with active infection, malignancy, end-stage renal disease, or end-stage liver disease were excluded.
Results: The study included 121 patients with ACS, 35.5% of whom had ST-elevation myocardial infarction (STEMI) and 64.5% had non-ST-elevation acute coronary syndrome (NSTE-ACS). Arterial hypertension was significantly more frequent in the NSTE-ACS group (p=0.02), while CRP levels 6 hours after PCI were significantly higher in the STEMI group (p=0.02). A trend toward increased CRP 12 hours after PCI was also observed in the STEMI group (p=0.05). Patients with STEMI and elevated CRP levels more frequently experienced complications such as post-infarction angina, reinfarction, and heart failure, while no mortality was recorded in either group.
Conclusion: This retrospective analysis highlights the prognostic value of CRP in acute coronary syndrome, particularly in STEMI, where higher CRP levels were associated with an increased risk of MACE. Although the association was less pronounced in NSTE-ACS, elevated CRP was still linked to a higher risk of post-infarction angina. The findings support the potential role of CRP in the early identification of high-risk patients, underscoring the need for further research with larger sample sizes and more sensitive measurement methods
Sudden Postpartum Collapse
No full textOvaj diplomski rad napisan je pod mentorstvo doc.Vladimira Blagaića, dr.med. te se bavi tematikom kolapsa rodilje u postporođajnom periodu. Cilj rada je pregledno predstaviti uzroke nastanka tog hitnog stanja te opisati kliničku sliku, dijagnostičke postupke te metode liječenja ovisno o tom uzroku. Poglavlje broj 3 „Uvod: Definicija, etiologija i prevalencija“ opisuje što je točno iznenadni postporođajni kolaps rodilje. Uzroke tog stanja prikazuje se jednog po jednog tako da se odvojeno opisuje definicija svakog uzroka, informacije o rizičnim faktorima i prikaz o tome koliko je pojedini uzrok čest. Poglavlje broj 4 se bavi isključivo jednim uzrokom postporođajnog kolapsa rodilje, odnosno bavi se o prevencijom primarne postpartalne hemoragije (PPH). Bitno je posvetiti cijelo poglavlje ovoj temi zato jer se prognoza pacijentica u slučajevima PPH-a značajno može poboljšati ukoliko je prevencija dobro provedena. Poglavlje broj 5 opisuje kliničku sliku te opisuje značajke u kliničkoj slici koje su specifične za pojedini uzrok postporođajnog kolapsa. Poglavlje broj 6 opisuje dijagnostičke metode koje liječnika dovode do pronalaska točnog uzroka postporođajnog kolapsa, što je dakako izuzetno bitno u pronalasku optimalne terapijske opcije. Na koncu, poglavlje broj 7 se bavi liječenjem ovog stanja te odabirom ispravne terapije koja dovodi do najboljeg razrješenja ovog hitnog stanja.This thesis, written under the mentorship of doc.Vladimir Blagaić, M.D., focuses on the topic of sudden maternal collapse in the postpartum period. The aim of the thesis is to provide a comprehensive overview of the causes of this emergency, as well as the description of the clinical presentation, diagnostic procedures, and treatment methods depending on the underlying cause. Chapter 3 defines what sudden postpartum collapse is. It discusses each cause individually, providing definitions, information about risk factors, and data on the frequency of each cause. Chapter 4 focuses exclusively on one cause of postpartum collapse — the prevention of primary postpartum hemorrhage (PPH). A full chapter is dedicated to this topic because effective prevention can significantly improve the prognosis of patients experiencing PPH. Chapter 5 describes the clinical presentation, highlighting features that are specific to each individual cause of postpartum collapse. Chapter 6 addresses the diagnostic methods that help physicians identify the exact cause of the collapse, which is crucial for determining the optimal therapeutic approach. Finally, Chapter 7 deals with the treatment of this condition and the selection of the appropriate therapy to achieve the best possible resolution of this emergency