Showing papers in "Lijec̆nic̆ki vjesnik in 2020"

ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection

Abstract: The COVID-19 pandemics is posing unprecedented challenges and threats to patients and healthcare systems worldwide Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients Patients with worst outcomes and higher mortality are reported to include immunocompromised subjects, namely older adults and polymorbid individuals and malnourished people in general ICU stay, polymorbidity and older age are all commonly associated with high risk for malnutrition, representing per se a relevant risk factor for higher morbidity and mortality in chronic and acute disease Also importantly, prolonged ICU stays are reported to be required for COVID-19 patients stabilization, and longer ICU stay may per se directly worsen or cause malnutrition, with severe loss of skeletal muscle mass and function which may lead to disability, poor quality of life and additional morbidity Prevention, diagnosis and treatment of malnutrition should therefore be routinely included in the management of COVID-19 patients In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing concise guidance for nutritional management of COVID-19 patients by proposing 10 practical recommendations The practical guidance is focused to those in the ICU setting or in the presence of older age and polymorbidity, which are independently associated with malnutrition and its negative impact on patient survival © 2020 Hrvatski Lijecnicki Zbor All rights reserved

Pobjede i porazi: borbe s pandemijama virusnih bolesti tijekom posljednjih stotinu godina

Abstract: The paper presents an overview of virus pandemics throughout the 20th and the 21st century and their main characteristics Selected examples of applied health protection measures are described, as well as cultural, political, economic, and public health responses to pandemics A rich heritage of preventive health protection specific for our territory, and its role in selecting protective health models during the coronavirus pandemic is emphasized © 2020 Hrvatski Lijecnicki Zbor All rights reserved

Glomerularne bolesti prije i nakon transplantacije bubrega

Abstract: Glomerular kidney diseases are one of the major causes of renal failure in patients preparing for kidney transplantation. Clinical monitoring of these patients may be a great challenge because of the variable course of various types of glomerular diseases, as well as the possibility of disease recurrence in the transplanted kidney. Focal segmental glomerulosclerosis, IgA nephropathy, C3 glomerulopathy, and membrane nephropathy before and after transplantation are described in this text. Risk factors and early detection of disease recurrence, clinical features, histologic characteristics, therapeutic options, modification of immunosuppressive therapy, and treatment outcomes for various forms of glomerulonephritis in the transplanted kidney are the topics of this review article.

Specific aspects of respiratory support in COVID-19 patients

Abstract: Acute hypoxemic respiratory failure is the main clinical feature of COVID-19 responsible for ICU admission In patients who develop respiratory failure,the choice of respiratory support depends on changes in respiratory mechanics, and the goal of this article is to differentiate between clinical and pathophysiological features beneath the respiratory failure in order to select optimal treatment In patients with preserved respiratory mechanics, lung compliance is normal and hypoxemia is caused by loss of hypoxic pulmonary vasoconstriction Prone positioning combined with high flow nasal oxygen (HFNO) or non-invasive ventilation (NIV) is the therapy of choice in these patients When acute respiratory distress syndrome (ARDS) is present, therapeutic approach is similar as with other viral pneumonias - initiation of mechanical ventilation via endotracheal tube, positive end expiratory pressure (PEEP) set to levels in which cyclic opening and closure of alveoli is avoided and fraction of inspired oxygen (FIO2) set to lowest possible levels needed to achieve arterial oxygen saturation of 90% In order to avoid patient-ventilator dyssynchrony the use of sedatives (such as midazolam or dexmedetomidine) and neuromuscular relaxants is recommended Extracorporeal support methods, such as extracorporeal membrane oxygenation and carbon dioxide removal which are proven to be effective when treating ARDS caused by other causes have not shown adequate efficacy in COVID-19 patients © 2020 Hrvatski Lijecnicki Zbor All rights reserved

Neočekivana otežana ekstubacija zbog mehaničkih uzroka nakon parotidektomije: prikaz bolesnice

Abstract: Difficult airway management usually refers to intubation or extubation problems. We present a case report of difficult extubation, and airway management algorithm that was used in a female patient following parotidectomy. Although there are algorithms for difficult airway management, there are no recommendations for difficult extubation that is mechanically caused and where endotracheal tube cannot be easily removed. Such conditions are rarely mentioned in the literature,usually in the form of case reports. Inability to remove endotracheal tube due to mechanical causes is an urgent condition and calls for an algorithm and guidelines. The algorithm that was performed in this case went uneventfully, and the patient recovered well.

COVID-19, five months later

Abstract: A new coronavirus, officially named SARS-CoV-2, that causes a new infectious disease COVID-19, emerged at the end of 2019 and conquered the whole world by devastating pandemics that by the middle of May 2020 infected 4 5 million people and caused 350,000 deaths After originating in China at the end of last December, the virus strongly hit Europe and afterwards the United States of America, which still records the daily growth of 25,000 new cases and makes the USA hardest hit country with 30% of all world cases The unemployment rates are growing in many affected countries and the International Monetary Fund has declared this pandemic the worst crisis since the depression at the beginning of the 20th century The pandemic has pushed numerous countries to intervene with strict epidemiologic preventive measures, introducing the infamous lockdown by closing traffic, schools, restaurants, any kind of public gatherings, urging people to stay at home and keep the social distance for weeks International and national air traffic has been minimalized, millions of people have lost their jobs, the world economy is continuously shrinking with slight chances for rapid recovery There are still many unknowns about the virus that scientists think first emerged in November 2019 This article reviews the current knowledge about epidemiologic, pathogenetic and clinical patterns of COVID-19, including perspective on therapy, vaccine and future pandemic development © 2020 Hrvatski Lijecnicki Zbor All rights reserved

Utjecaj intrapartalne analgezije petidinom ili tramadolom na opstetričke ishode – usporedbeno dvostruko slijepo randomizirano prospektivno intervencijsko istraživanje

Abstract: Deskriptori OPSTETRIČKA ANALGEZIJA – metode; OPIOIDNI ANALGETICI – nuspojave, terapijska uporaba; TRAMADOL – farmakologija, nuspojave, terapijska uporaba; MEPERIDIN – farmakologija, nuspojave, terapijska uporaba; POROĐAJNA BOL – farmakoterapija; KARDIOTOKOGRAFIJA; APGAR OCJENA, PROSPEKTIVNA ISTRAŽIVANJA; DVOSTRUKO SLIJEPA ISTRAŽIVANJA SAŽETAK. Cilj: Cilj istraživanja bila je usporedba djelovanja tramadola i petidina tijekom porođaja na opstetričke ishode (njihov analgetski učinak, trajanje porođaja, pojavnost nuspojava u rodilja i neonatalni status). Metode: Djelovanje analgetika ispitano je prospektivnim usporedbenim (engl. head-to-head) randomiziranim dvostruko slijepim intervencijskim istraživanjem na uzorku od 60 rodilja tijekom ročnog porođaja. U istraživanju su upotrijebljene doze tramadola i petidina od 50 mg primijenjene intravenski. Pri analizi podataka služili smo se testom razlike u proporcijama dvaju nezavisnih skupova i Studentovim t-testom. Prije provedbe t-testa normalnost je ispitana Kolmogorov-Smirnovljevim testom. Rezultati: Primjena tramadola povezana je s manje prijavljenih nuspojava te kraćim trajanjem porođaja u odnosu prema skupini rodilja liječenih petidinom. Analizom analgetskog učinka statistički značajno niža vrijednost boli nakon 10 minuta i 30 minuta utvrđena je u pacijentica kojima je primijenjen petidin u odnosu prema onima na tramadolu, uz negativnu razliku osjeta boli u obje promatrane točke mjerenja. Efekt primjene tramadola iščeznuo je nakon 30 minuta. Nisu utvrđene statistički značajne razlike u karakteristikama CTG zapisa, Apgarina zbroja, vrijednosti pH iz pupkovine. Zaključak: Prema rezultatima istraživanja, tramadol skraćuje trajanje porođaja, a petidin ima jači analgetski učinak, ali i više neugodnih nuspojava za majku. Neonatalni je ishod neovisan o vrsti opioida.

Recommendations of the Working group of the Croatian Society for Diabetes and Metabolic Disorders of the Croatian Medical Associationfor people with diabetes and healthcare professionals in the Republic of Croatia during COVID-19 pandemic

Abstract: The Working group of the Croatian Society for Diabetes and Metabolic Disorders of the Croatian Medical Association has prepared recommendations for people with diabetes and healthcare professionals in the age of COVID-19 pandemic. The recommendations emphasized the scale of the pandemic and the possible consequences for those suffering from diabetes. Enclosed are clinical presentation and directions of the National civil protection headquarters on the methods that enable people with diabetes to protect themselves, and maintain their blood glucose in target range as well. Measures have been proposed to be implemented by healthcare facilities that deliver care for patients with diabetes, and the principles of glycemic control in emergency department and during hospitalization.

Psihičko zdravlje liječnika u Hrvatskoj za vrijeme pandemije COVID-19

Abstract: Research aim: The aim of this research is to compare health concerns and behaviours, as well as mental health indicators, among members of the general population and physicians during the COVID-19 pandemic in Croatia. Participants and methods: The research was conducted in March and April of 2020 with two samples. The sample of physicians consisted of 723 participants, most of whom were women (71.9%) aged between 26 and 81 years (M = 48.3; SD = 11.26). The sample from the general population included 780 participants, who were also predominantly women (72.7%) with an age range of 19 to 77 years (M = 40.2; SD = 12.27). All participants completed the COVID-19 Behaviour Questionnaire, the COVID-19 Care Scale and the Pandemic Care Scale. The CORE-YP and quality of life assessment were used as indicators of mental health. Results: In comparison to the general population, physicians demonstrate more pronounced concerns about COVID-19 and about the overall function of the health care system. They are less concerned about their own mental health, are not more psychologically distressed, nor do they have a poorer quality of life than the general population. However, physicians indicated more pronounced difficulty sleeping and were less inclined to talk about their difficulties, but had the impression of adequate social support and self-efficacy. Although there is no difference between physicians and the general population in terms of general levels of psychological distress, distress is significantly higher in both groups than during the period prior to the pandemic. Conclusions: While the pandemic has caused situation specific concerns among physicians, the degree of general anxiety and level of estimated quality of life are the same as that observed in the general population. Although the results from international research to date would lead one to expect that mental health among physicians during the pandemic would deteriorate, this was not confirmed by our results. One of the possible reasons for this finding is the favourable epidemiological situation in Croatia, which exhibited a linear increase in COVID-19 cases over the pandemic period.

Utjecaj primjene različitih tehnika anestezije na imunosni odgovor organizma: pregled literature

Abstract: The immune system comprises both specific and non-specific immunity. The immune response during the perioperative period is modulated by tissue trauma, fear/anxiety, medication, hypothermia, pain, transfusion of blood products, glycaemia regulation, infection and increased stress. Anaesthesia can influence the stress response by central modulation (general anaesthesia), afferent blockade (regional anaesthesia), or by interaction with the endocrine system. The choice of anaesthetic technique seems to have an influence on cancer cells and their possible dissemination. The aims of this review article are to review the effects of regional anaesthesia in comparison to general anaesthesia (intravenous and inhalational) on the immune response to surgical stress, malignant disease progression and postoperative organ function. It is known that general anaesthesia can suppress cellular and humoral immunity by acting on immune-competent cells, gene expression and secretion of inflammatory mediators. Opioids and/or their mode of administration show a different effect on the immune system: immune suppression, immune stimulation or both. In contrast, local anaesthetics are efficient in treating acute and chronic inflammation because they deactivate inflammatory processes on different levels, including the monocyte-macrophage system, decrease of oxygen metabolites and free radical formation, histamine liberation, release of interleukin (IL-1α) and leukotriens. To minimise or avoid immune reactions, the use of local and regional anaesthesia is recommended, as it is superior to other analgesic methods and also reduces postoperative blood loss. Because of these significant advantages, today the use of regional anaesthesia is widespread in oncological surgery.

Prikaz slučaja novorođenčeta s gastroshizom i duplikaturom žučnog mjehura

Abstract: Gastroschisis is a defect of the anterior abdominal wall through which viscera can protrude, and can be followed by additional malformations. Three quarters of the gastroschisis malformations are confined to the midgut. Other malformations are urologic and cardiac malformations and malformations of extrahepatic biliary tract. Duplication of gallbladder in general population is relatively rare, occurring once in every 3,000 to 4,000.In this case report we will present a case of an infant with gastroschisis accompanied with the duplication of gallbladder. In the newborn a complete duplication of gallbladder was found with two separate cystic ducts, i.e. type 2 by Boyden. Since the guidelines for duplication of the gallbladder associated with gastroschisis do not exist, we acted according to the guidelines for duplication of the gallbladder in the general population, i.e. nonsurgical intervention was performed on the biliary tree. Duplications of the gallbladder associated with gastroschisis do not require active surgical treatment, unless they are symptomatic or if there is other malformation of the biliary system.