Croatian Medical Journal最新文献

Aim: To assess the efficacy of a multidisciplinary tube-weaning program.

Methods: This retrospective cohort study enrolled children with feeding tube dependency who had not responded to standard tube-weaning interventions. All participants underwent a structured two-week multidisciplinary tube weaning delivered in a day-hospital setting at the Children's Hospital Zagreb in the period from August 2016 to February 2023. The program was based on a hunger-induction approach and combined with mealtime therapy, sensory integration therapy, parental group therapy and individual support, nutritional counseling, and a workshop for parents. The outcomes were evaluated at the beginning of the program, the end of the program, 3-6 months after the program, and at the last follow-up.

Results: The study enrolled 30 patients (mean age 2.6±1.9 years; 60.0% girls). All patients had complex medical conditions and were tube-dependent for a mean of 29±22 months. The majority (70.0%) had a psychomotor delay. At the end of the program, 27 (90.0%) patients showed improved oral intake, and 10 (33.3%) were completely weaned off tube feeding. During follow-up (mean 40.5 months, n=24 children), 18 children (78.0%) were weaned off tube feeding.

Conclusions: A two-week program effectively improved oral intake and resulted in a high success rate for tube weaning in the long term.

Aim: To assess the optimal fusion angle of the elbow to accommodate the activities of daily living.

Methods: The study enrolled 30 healthy adult volunteers (mean age 24 years), who performed 29 activities with an elbow brace fixed at various flexion angles (30°, 50°, 70°, 90°, 110°, 120°). The activities were divided into three groups: the activities of daily living, personal care and hygiene, and modern activities of daily living. Activity performance was scored on a scale previously designed to assess the difficulty of performing a particular activity. Results, The highest overall score for all activities was at 90° elbow flexion (79.70±4.11), followed by 110° (76.17±4.01) and 70° (75.43±6.64). For modern activities of daily living, the highest score (43.77±1.33) was also at 90°. The 90° angle also allowed the highest percentage (86.6%) of task completion in all activity groups. Conclusion, Our study supports making elbow arthrodesis at 90° of flexion, which may also be applied to modern daily living activities. However, patients should be consulted about the preferred angle for elbow arthrodesis, as no single fusion angle allows for the performance of all modern daily living activities.

Aim: To inventory the content of home pharmacies and evaluate drug keeping and self-medication practices in the households of medical and pharmacy students at Zagreb University in 2022, and to relate the findings to two previous surveys.

Methods: A cross-sectional survey enrolled 178 students who inventoried drug supplies in their family households, and interviewed household members on drug keeping and self-medication practices. Previous surveys included 287 (in 2001) and 225 (in 1977) students/households.

Results: In most households, medicines were kept at a designated place (around 65%, all surveys) but commonly contained products past the expiry dates or of unknown purpose (59% vs 27%-32% previously). Analgesics-antipyretics were kept in practically all households (93%-97% across all surveys), followed by cough-cold relief products (55% vs 30%-33% households) and anti-allergic drugs (systemic) (44% vs 25% households). These drug classes were commonly used for self-medication (all surveys). Of the typical prescription drugs, the most common were benzodiazepines (34% vs 24% previously), which were at least occasionally used for self-medication in 40% of such households. Systemic antibiotics were found in 17% of the households (vs 40%-46% previously), and the tendency of self-medication was less common (20% vs around 40% of the households).

Conclusions: The patterns observed in households with expected above-average drug literacy and access (future health care professionals, health care professionals common among household members) in three surveys completed across 50 years were discrepant with "responsible self-medication" (drug handling, storage, usage). As such, they emphasize a general need for improved awareness about this topic.

Aim: To evaluate the effect of cooled endotracheal tubes on the incidence of postoperative sore throat, hoarseness, coughing, and dysphagia after endotracheal intubation.

Methods: This randomized controlled trial enrolled patients undergoing elective surgery under general anesthesia with endotracheal intubation at Adana Dr Turgut Noyan Hospital between April and September 2023. The patients were randomly assigned to be intubated with endotracheal tubes refrigerated at +4 °C for 4-6 hours before intubation (n=66) or with endotracheal tubes kept at the operating room temperature (+20-23 °C) (n=70). The incidence of sore throat, hoarseness, coughing, and dysphagia was recorded at 1, 4, 12, and 24 hours postoperatively.

Results: The groups did not significantly differ in the incidence of sore throat, hoarseness, and coughing at 1 hour and 24 hours. They also did not differ in the incidence of dysphagia at 24 hours.

Conclusion: Cooled endotracheal tubes are not superior to tubes kept at operating room temperature in reducing postoperative sore throat, hoarseness, coughing, or dysphagia.

Aim: To systematically review randomized controlled trials evaluating the efficacy of sleep-oriented non-pharmacological interventions for delirium prevention in intensive care units.

Methods: We searched PubMed, Web of Science, Scopus, and the Cochrane Library for randomized controlled trials evaluating the efficacy of sleep-oriented, non-pharmacological interventions for delirium prevention in intensive care units published in English between 2019 and 2024. The methodological quality of the included studies was independently evaluated by two researchers using the Joanna Briggs Institute tool.

Results: This review included eight randomized controlled trials (n = 649). Six studies assessed the effect of earplugs and masks on delirium prevention in intensive care patients. Three studies indicated that earplugs and eye masks effectively prevented delirium, while three studies found no effect. One study assessed the use of earplugs and masks as part of a bundle of interventions and reported a positive effect. Four studies showed an effect on sleep. None of the sleep-oriented non-pharmacological interventions assessed in these studies reported any harmful effects.

Conclusion: Although several high-quality studies showed that these interventions significantly lowered delirium incidence, some trials found no effect, highlighting variability in outcomes.

Aim: To assess whether the Mini-Mental State Examination, second edition (MMSE-2), scores were associated with the category of functional independence of nursing-home residents and the level of accommodation services they received.

Methods: This cross-sectional study enrolled 248 participants older than 65 residing in five county-owned nursing homes in the city of Zagreb from 2017 to 2019. Cognitive status was assessed with the standard version of the MMSE-2, and the level of functional independence with the modified Barthel scale index. We collected data on demographic, clinical, and social characteristics, including the level of accommodation services (I-III).

Results: MMSE scores were associated with the category of functional independence (χ2=21.11; P<0.001) and the level of accommodation services provided to nursing-home residents (χ2=38.87; P<0.001).

Conclusion: Cognitive impairment should be determined in nursing-home residents to facilitate the planning of long-term institutional care and the implementation of the prescribed standards based on the level of accommodation services.

Locally advanced renal cell carcinoma (RCC) presents significant therapeutic challenges, particularly in resource-limited settings with restricted access to new therapies. This report describes a new exploratory multimodal therapeutic approach for a patient with locally advanced clear cell RCC (ccRCC) with adrenal and lymph node metastases. A 45-year-old woman presented with an incidentally discovered 9-cm mass in the left kidney, which was later diagnosed as grade-2 ccRCC with adrenal and lymph node involvement. After radical nephrectomy, a multimodal treatment regimen consisting of sunitinib, pembrolizumab, bevacizumab, sirolimus, and zoledronic acid was initiated. Following eight cycles of treatment, computed tomography imaging and ultrasound showed considerable tumor shrinkage, with residual mass decreasing from 22 × 42 mm to 22 × 18 mm, which constituted a "radiologically complete response." The patient had compensatory hypertrophy of the contralateral kidney with preserved renal function. This case illustrates the potential efficacy of a novel multimodal treatment strategy combining targeted therapies, immunotherapy, and bone-modifying agents in a resource-limited setting. Further research is needed to validate this approach in larger, diverse patient cohorts.