Pub Date : 2023-01-01DOI: 10.5937/scriptamed54-42419
D. Knezevic, Duška Jović, M. Petković
Background/Aim: Diarrhoea that occurs as a result of the presence of Clostridium difficile (reclassified as Clostridioides difficile) is usually manifested as a hospital infection, usually after antibiotic treatment. The study aim was to assess the incidence, characteristics and outcomes of hospitalised patients with healthcare - associated Clostridioides difficile infection (HA - CDI) before and during the COVID-19 pandemic. Methods: This retrospective cohort study included patients older than 18, who met the HA - CDI case definition. The CDI diagnosis was made by demonstrating toxins A and B in stool samples using an immunochromatographic assay test and polymerase chain reaction (PCR). Results: The incidence of HA - CDI has significantly decreased from the preCOVID-19 period to the COVID-19 period (11.04 per 10,000 vs 6.49 per 10,000, p < 0.001). Before establishing the HA - CDI diagnosis, 41.4 % of patients used one antibiotic, 25.9 % used two and 11.2 % were treated with three or more antibiotics. Almost one half of the applied antibiotics were from the group that represents high risk for the development of HA - CDI. Multivariable logistic regression analysis showed that older age (OR = 3.4; 95 % CI = 0.9-12.4; p = 0.038) and complicated disease course (OR = 11.8; 95 % CI = 2.6-53.6; p ≤ 0.001) were associated with a higher risk of death. Conclusion: The incidence of HA - CDI has decreased during the observed period of the COVID-19 pandemic, however, no clear connection between the impact of the pandemic and incidence reduction was found. Due to unfavourable outcome of the treatment of HA - CDI patients during COVID-19 pandemic, the rational use of antibiotics is necessary.
背景/目的:由于艰难梭菌(重新分类为艰难梭菌)的存在而发生的腹泻通常表现为医院感染，通常在抗生素治疗后。该研究的目的是评估在COVID-19大流行之前和期间与医疗保健相关的艰难梭菌感染(HA - CDI)住院患者的发病率、特征和结局。方法:本回顾性队列研究纳入18岁以上符合HA - CDI病例定义的患者。CDI诊断是通过使用免疫层析试验和聚合酶链反应(PCR)在粪便样本中显示毒素A和B来进行的。结果:HA - CDI的发病率从COVID-19前期到COVID-19期间明显下降(11.04 / 10,000 vs 6.49 / 10,000, p < 0.001)。在确定HA - CDI诊断之前，41.4%的患者使用一种抗生素，25.9%使用两种抗生素，11.2%使用三种或三种以上抗生素。几乎一半的应用抗生素来自HA - CDI发展高风险的群体。多变量logistic回归分析显示，年龄较大(OR = 3.4;95% ci = 0.9-12.4;p = 0.038)和复杂病程(OR = 11.8;95% ci = 2.6-53.6;P≤0.001)与较高的死亡风险相关。结论:在新冠肺炎大流行观察期间，HA - CDI发病率有所下降，但大流行的影响与发病率下降之间没有明确的联系。由于COVID-19大流行期间HA - CDI患者治疗效果不佳，合理使用抗生素是必要的。
{"title":"Epidemiological and clinical characteristics of patients with healthcare: Associated Clostridioides difficile infection before and during the COVID-19 pandemic","authors":"D. Knezevic, Duška Jović, M. Petković","doi":"10.5937/scriptamed54-42419","DOIUrl":"https://doi.org/10.5937/scriptamed54-42419","url":null,"abstract":"Background/Aim: Diarrhoea that occurs as a result of the presence of Clostridium difficile (reclassified as Clostridioides difficile) is usually manifested as a hospital infection, usually after antibiotic treatment. The study aim was to assess the incidence, characteristics and outcomes of hospitalised patients with healthcare - associated Clostridioides difficile infection (HA - CDI) before and during the COVID-19 pandemic. Methods: This retrospective cohort study included patients older than 18, who met the HA - CDI case definition. The CDI diagnosis was made by demonstrating toxins A and B in stool samples using an immunochromatographic assay test and polymerase chain reaction (PCR). Results: The incidence of HA - CDI has significantly decreased from the preCOVID-19 period to the COVID-19 period (11.04 per 10,000 vs 6.49 per 10,000, p < 0.001). Before establishing the HA - CDI diagnosis, 41.4 % of patients used one antibiotic, 25.9 % used two and 11.2 % were treated with three or more antibiotics. Almost one half of the applied antibiotics were from the group that represents high risk for the development of HA - CDI. Multivariable logistic regression analysis showed that older age (OR = 3.4; 95 % CI = 0.9-12.4; p = 0.038) and complicated disease course (OR = 11.8; 95 % CI = 2.6-53.6; p ≤ 0.001) were associated with a higher risk of death. Conclusion: The incidence of HA - CDI has decreased during the observed period of the COVID-19 pandemic, however, no clear connection between the impact of the pandemic and incidence reduction was found. Due to unfavourable outcome of the treatment of HA - CDI patients during COVID-19 pandemic, the rational use of antibiotics is necessary.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85097012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5937/scriptamed54-42460
M. Nusier, V. Elimban, Jaykishan Prasad, A. Shah, N. Dhalla
Various protein kinases including protein kinase A (PKA), Ca2+-calmodulin kinase (CaMK), phosphoinositide 3-kinase (PI3K), protein kinase C (PKC) and mitogen-activated protein kinase (MAPK: ERK1/2, p38-MAPK and JNK) are integral part of different signal transduction pathways, which are known to regulate cardiac structure, function and metabolism. In addition, these signal transducing proteins are involved in the regulation of cation transport, cellular growth, gene expression, apoptosis and fibrosis by modifying the function of different target sites of subcellular organelles in the myocardium. However, the information regarding these signal transducing molecules is scattered and mechanisms of their involvement in diverse regulatory processes are poorly understood. While PKA, CaMK, PI3K and PKC are activated by different hormones and mechanical stimuli, MAPKs are activated by growth factors and some cellular stresses such as oxidative stress, inflammation and Ca2+-overload. Each type of these protein kinases is expressed in the form of two or more isozymes showing different biochemical characteristics and distinct biological functions. It has been demonstrated that all specific isoforms of these kinases produce both beneficial and detrimental effects on the heart, which are dependent upon the intensity and duration of stimulus for their activation. While PKA, PKC and CaMK are mainly involved in augmenting cardiac function as well as inducing cardiac hypertrophy and arrhythmias, PI3K is mainly involved in maintaining b-adrenoceptor function and inducing inflammation as well as arrhythmias. On the other hand, ERK1/2 mainly participate in the genesis of cardiac hypertrophy and cytoprotection whereas p38-MAPK and JNK are primarily involved in cardiac dysfunction, apoptosis and fibrosis. Since the activities of most protein kinases are increased under prolonged pathological conditions, a wide variety of their inhibitors have been shown to produce beneficial effects. However, extensive research needs to be carried out to understand the pathophysiology of different isoforms of each protein kinase as well as for the development of their isoform-specific inhibitors.
{"title":"Regulatory role of some protein kinases in signal transduction pathways in heart health and disease","authors":"M. Nusier, V. Elimban, Jaykishan Prasad, A. Shah, N. Dhalla","doi":"10.5937/scriptamed54-42460","DOIUrl":"https://doi.org/10.5937/scriptamed54-42460","url":null,"abstract":"Various protein kinases including protein kinase A (PKA), Ca2+-calmodulin kinase (CaMK), phosphoinositide 3-kinase (PI3K), protein kinase C (PKC) and mitogen-activated protein kinase (MAPK: ERK1/2, p38-MAPK and JNK) are integral part of different signal transduction pathways, which are known to regulate cardiac structure, function and metabolism. In addition, these signal transducing proteins are involved in the regulation of cation transport, cellular growth, gene expression, apoptosis and fibrosis by modifying the function of different target sites of subcellular organelles in the myocardium. However, the information regarding these signal transducing molecules is scattered and mechanisms of their involvement in diverse regulatory processes are poorly understood. While PKA, CaMK, PI3K and PKC are activated by different hormones and mechanical stimuli, MAPKs are activated by growth factors and some cellular stresses such as oxidative stress, inflammation and Ca2+-overload. Each type of these protein kinases is expressed in the form of two or more isozymes showing different biochemical characteristics and distinct biological functions. It has been demonstrated that all specific isoforms of these kinases produce both beneficial and detrimental effects on the heart, which are dependent upon the intensity and duration of stimulus for their activation. While PKA, PKC and CaMK are mainly involved in augmenting cardiac function as well as inducing cardiac hypertrophy and arrhythmias, PI3K is mainly involved in maintaining b-adrenoceptor function and inducing inflammation as well as arrhythmias. On the other hand, ERK1/2 mainly participate in the genesis of cardiac hypertrophy and cytoprotection whereas p38-MAPK and JNK are primarily involved in cardiac dysfunction, apoptosis and fibrosis. Since the activities of most protein kinases are increased under prolonged pathological conditions, a wide variety of their inhibitors have been shown to produce beneficial effects. However, extensive research needs to be carried out to understand the pathophysiology of different isoforms of each protein kinase as well as for the development of their isoform-specific inhibitors.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85470728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5937/scriptamed54-43352
A. Mandić, N. Nikolic, S. Maričić, B. Gutic, N. Stevanovic, Branka Basica
Background/Aim: Geotropism of the human papillomavirus (HPV) represents the heterogeneous distribution of different genotypes worldwide. Aim of this study was to evaluate the prevalence of the HPV infection in women from Vojvodina, Serbia, according to cytological status and pathological changes of cervix - dysplasia and cancer. Methods: The research was conducted as a retrospective study at the Oncology Institute of Vojvodina and the Institute of Public Health of Vojvodina (IPHV). Data from the medical records of female patients treated for cervical intraepithelial neoplasia or cervical cancer at the Department of Gynaecology, Clinic for Surgical Oncology, Oncology Institute of Vojvodina in Sremska Kamenica in the period from 2016 to 2021 were used, as well as the laboratory findings of the IPHV for a group of patients with normal cytological results of the Papanikolau (PAPA) smear. Results: A total of 731 women, from 20 to 82 years of age, with different cytological results were enrolled. 567 samples were classified as NILM, while 164 samples belong to a group of abnormal histopathology (LSIL/HSIL/cervical cancer). The HPV genotyping assay was performed using the EUROArray HPV test to detect 30 HPV genotypes. In the overall number with normal cytological findings, HPV infection was verified in 242 (42.7 %) patients, of which 135 (55.8 %) were verified with high risk HPV, while 76 (31.4 %) were verified with a mixed group of HPV (Low risk/High risk HPV). Most prevalent genotypes were HPV 16, 31, 53, 51 and 18 in NILM cytological status. In the samples with the abnormal histopathology, the most prevalent genotypes were HPV 16, 33, 31 and 56, while 18 and 39 were equally verified. Genotype 16 was the most prevalent in the examined sample, with a higher prevalence in higher-grade histopathological findings: 18.8 % in LSIL, 31.9 % in HSIL and 75.0 % in cervical cancer samples. Infection with multiple associated genotypes of HPV was not correlated with histopathology. By comparing histopathological diagnosis and age, older patients had higher-grade lesions. Conclusion: Based on the estimated oncogenic potential of HPV genotypes as well as their prevalence in presented sample, it can be concluded that the nine-valent HPV vaccine for genotypes 6, 11, 16, 18, 31, 33, 45, 52 and 58 would have the potential to prevent HPV infection and the incidence of precancerous lesions and cervical cancer in about 85 % of women. Observing trends in the prevalence of HPV, especially HR HPV genotypes, can be important in the further strategy of applying secondary and primary prevention, as well as the application of HPV detection as part of co-testing or considering the introduction of HPV testing in the initial screening program.
{"title":"Geotropism and oncogenic potential of HPV infections in cohort study populations in Vojvodina, North region of Serbia","authors":"A. Mandić, N. Nikolic, S. Maričić, B. Gutic, N. Stevanovic, Branka Basica","doi":"10.5937/scriptamed54-43352","DOIUrl":"https://doi.org/10.5937/scriptamed54-43352","url":null,"abstract":"Background/Aim: Geotropism of the human papillomavirus (HPV) represents the heterogeneous distribution of different genotypes worldwide. Aim of this study was to evaluate the prevalence of the HPV infection in women from Vojvodina, Serbia, according to cytological status and pathological changes of cervix - dysplasia and cancer. Methods: The research was conducted as a retrospective study at the Oncology Institute of Vojvodina and the Institute of Public Health of Vojvodina (IPHV). Data from the medical records of female patients treated for cervical intraepithelial neoplasia or cervical cancer at the Department of Gynaecology, Clinic for Surgical Oncology, Oncology Institute of Vojvodina in Sremska Kamenica in the period from 2016 to 2021 were used, as well as the laboratory findings of the IPHV for a group of patients with normal cytological results of the Papanikolau (PAPA) smear. Results: A total of 731 women, from 20 to 82 years of age, with different cytological results were enrolled. 567 samples were classified as NILM, while 164 samples belong to a group of abnormal histopathology (LSIL/HSIL/cervical cancer). The HPV genotyping assay was performed using the EUROArray HPV test to detect 30 HPV genotypes. In the overall number with normal cytological findings, HPV infection was verified in 242 (42.7 %) patients, of which 135 (55.8 %) were verified with high risk HPV, while 76 (31.4 %) were verified with a mixed group of HPV (Low risk/High risk HPV). Most prevalent genotypes were HPV 16, 31, 53, 51 and 18 in NILM cytological status. In the samples with the abnormal histopathology, the most prevalent genotypes were HPV 16, 33, 31 and 56, while 18 and 39 were equally verified. Genotype 16 was the most prevalent in the examined sample, with a higher prevalence in higher-grade histopathological findings: 18.8 % in LSIL, 31.9 % in HSIL and 75.0 % in cervical cancer samples. Infection with multiple associated genotypes of HPV was not correlated with histopathology. By comparing histopathological diagnosis and age, older patients had higher-grade lesions. Conclusion: Based on the estimated oncogenic potential of HPV genotypes as well as their prevalence in presented sample, it can be concluded that the nine-valent HPV vaccine for genotypes 6, 11, 16, 18, 31, 33, 45, 52 and 58 would have the potential to prevent HPV infection and the incidence of precancerous lesions and cervical cancer in about 85 % of women. Observing trends in the prevalence of HPV, especially HR HPV genotypes, can be important in the further strategy of applying secondary and primary prevention, as well as the application of HPV detection as part of co-testing or considering the introduction of HPV testing in the initial screening program.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91220487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5937/scriptamed54-44234
Nursalam Nursalam, Mira Triharini, Awatiful Azza, Chanif Chanif, Erna Wahyuni, Machmudah Machmudah, Nurus Safaah, Sri Utami, Tiyas Kusumaningrum, Wiwit Nurbadriyah, Satriya Pranata
Background/Aim: Previous research obtained information that chemotherapy patients need more spirituality than patients with other diseases because chemotherapy patients feel that their illness is difficult to heal and will last forever, until the end of their lives. The purpose of this study was to find a relationship between spiritual qualities and the self-acceptance of cancer patients receiving chemotherapy. Methods: The study sample was 125 patients in chemotherapy. The investigative method used a correlation with a cross-sectional approach. The spiritual quality questionnaire was based on the spiritual well-being scale measurement technique which contained 3 components, namely spirituality and faith, emotional support and meaning in life. The instrument consisted of 20 multiple-choice questions with 6 Likert measurement scales. Data analysis used univariate and bivariate analysis. The significance level was set at p < 0.05. Results: The results of the investigation showed that there was a significant positive relationship between spiritual quality and self-adaptation of respondents who were cancer patients who received chemotherapy in the Flamboyan Room of Balaidhika Husada Hospital Jember, Indonesia as evidenced by a significant p < 0.01. Conclusion: This study showed positive correlation between spiritual quality and self-adaptation of cancer patients receiving chemotherapy. The results of this study can assist nurses in providing chemotherapy patient care through a spiritual approach.
{"title":"The relationship between spiritual quality and self-adaptation in cancer patients receiving chemotherapy","authors":"Nursalam Nursalam, Mira Triharini, Awatiful Azza, Chanif Chanif, Erna Wahyuni, Machmudah Machmudah, Nurus Safaah, Sri Utami, Tiyas Kusumaningrum, Wiwit Nurbadriyah, Satriya Pranata","doi":"10.5937/scriptamed54-44234","DOIUrl":"https://doi.org/10.5937/scriptamed54-44234","url":null,"abstract":"Background/Aim: Previous research obtained information that chemotherapy patients need more spirituality than patients with other diseases because chemotherapy patients feel that their illness is difficult to heal and will last forever, until the end of their lives. The purpose of this study was to find a relationship between spiritual qualities and the self-acceptance of cancer patients receiving chemotherapy. Methods: The study sample was 125 patients in chemotherapy. The investigative method used a correlation with a cross-sectional approach. The spiritual quality questionnaire was based on the spiritual well-being scale measurement technique which contained 3 components, namely spirituality and faith, emotional support and meaning in life. The instrument consisted of 20 multiple-choice questions with 6 Likert measurement scales. Data analysis used univariate and bivariate analysis. The significance level was set at p < 0.05. Results: The results of the investigation showed that there was a significant positive relationship between spiritual quality and self-adaptation of respondents who were cancer patients who received chemotherapy in the Flamboyan Room of Balaidhika Husada Hospital Jember, Indonesia as evidenced by a significant p < 0.01. Conclusion: This study showed positive correlation between spiritual quality and self-adaptation of cancer patients receiving chemotherapy. The results of this study can assist nurses in providing chemotherapy patient care through a spiritual approach.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135843063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5937/scriptamed54-44752
Jelica Predojević-Samardžić, Nina Maric, O. Ljuboja
Background/Aim: Ventricular septal defect (VSD) is the most common congenital heart anomaly that in many cases closes spontaneously. The spontaneous closure (SC) rate of VSD varies widely between studies. The aim of this study was to identify clinical and echocardiographic factors influencing SC of isolated VSD in the first year of life among a group of patients presented at the Paediatric Clinic. Methods: Prospective study was performed in 60 consecutive patients with trivial, small or medium isolated VSD during the first year of life. Patients were divided into groups, according to gender and gestational age of the patient, type, number and the size of the defect and persistence of pulmonary hypertension. The size of defect was described in comparison to the diameter of the aortic annulus (VSD/Ao ratio). Results: At the time of diagnosis, the mean VSD/Ao ratio was 0.33 mm. Muscular VSD was more common (76.7 %) than perimembranous (23.3 %). SC of VSD occurred in 60 % of all patients, in case of muscular defect in 73.9 % and in case of perimembranous in 14.3 %. There was a negative correlation between defect size and SC rate. SC probability for a given defect size was described by the formula: probability = -1.82933X+1.20145. None defect with pulmonary hypertension closed. Conclusion: It was found that type and size of VSD and the persistence of pulmonary hypertension were significant predictors for SC, while gender and gestational age of the patient and the number of defects were not. This study can be useful in predicting the natural outcome of the VSD to make proper follow-up and management plans.
{"title":"Spontaneous closure of isolated Ventricular septal defect in the first year","authors":"Jelica Predojević-Samardžić, Nina Maric, O. Ljuboja","doi":"10.5937/scriptamed54-44752","DOIUrl":"https://doi.org/10.5937/scriptamed54-44752","url":null,"abstract":"Background/Aim: Ventricular septal defect (VSD) is the most common congenital heart anomaly that in many cases closes spontaneously. The spontaneous closure (SC) rate of VSD varies widely between studies. The aim of this study was to identify clinical and echocardiographic factors influencing SC of isolated VSD in the first year of life among a group of patients presented at the Paediatric Clinic. Methods: Prospective study was performed in 60 consecutive patients with trivial, small or medium isolated VSD during the first year of life. Patients were divided into groups, according to gender and gestational age of the patient, type, number and the size of the defect and persistence of pulmonary hypertension. The size of defect was described in comparison to the diameter of the aortic annulus (VSD/Ao ratio). Results: At the time of diagnosis, the mean VSD/Ao ratio was 0.33 mm. Muscular VSD was more common (76.7 %) than perimembranous (23.3 %). SC of VSD occurred in 60 % of all patients, in case of muscular defect in 73.9 % and in case of perimembranous in 14.3 %. There was a negative correlation between defect size and SC rate. SC probability for a given defect size was described by the formula: probability = -1.82933X+1.20145. None defect with pulmonary hypertension closed. Conclusion: It was found that type and size of VSD and the persistence of pulmonary hypertension were significant predictors for SC, while gender and gestational age of the patient and the number of defects were not. This study can be useful in predicting the natural outcome of the VSD to make proper follow-up and management plans.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75297115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5937/scriptamed54-41898
Akash Kumar, A. Hosangadi, M. Ramesh
Background/Aim: Wound management of the compound open tibia (Gustilo-Anderson grade 2, 3a, 3b) is complicated by a higher infection and the problem of adequate soft tissue coverage is significant. Primary wound closure is not easily advisable in these types of compound open tibial fractures. Early tissue flap or graft procedure might increase the complication rate due to temporary graft rejection and wound infections. The aim of this study was to analyse the duration required for formation of healthy granulation tissue, duration required for making wound fit for skin cover procedure and duration of hospital stay in compound open tibia fracture treated with vacuum assisted closure (VAC). Methods: A prospective interventional study of 22 patients aged 18 to 60 years was done. After assessing the size of the wound, primary bone fixation and wound debridement were carried out as soon as possible and then VAC was applied. Assessment of VAC therapy was based on mean decreases in wound size and "modified Johner and Wruh's criteria", used for assessment of the functional outcome of tibial shaft fracture was recorded during each follow-up. Results: Twenty two patients suffered comminuted open fractures of tibia-fibula. Primary fixation of bone were done with vacuum dressing. During follow-up, the good decrease in wound size considering vacuum dressing remedy was once 18.75 ± 18.36 cm2 (p = 0.001). Six patients achieved excellent results according to "modified Johner and Wruh's criteria" of tibial shaft fracture. Conclusion: This technique effectively reduced wound size, accelerated the formation of healthy granulation tissue of wound with open fracture bone and provided a better functional outcome. The VAC treatment had suggestively increased wound closure rate, decreased morbidity and costs for patients.
{"title":"Outcome of vacuum assisted dressing in open comminuted tibial fracture with primary fixation","authors":"Akash Kumar, A. Hosangadi, M. Ramesh","doi":"10.5937/scriptamed54-41898","DOIUrl":"https://doi.org/10.5937/scriptamed54-41898","url":null,"abstract":"Background/Aim: Wound management of the compound open tibia (Gustilo-Anderson grade 2, 3a, 3b) is complicated by a higher infection and the problem of adequate soft tissue coverage is significant. Primary wound closure is not easily advisable in these types of compound open tibial fractures. Early tissue flap or graft procedure might increase the complication rate due to temporary graft rejection and wound infections. The aim of this study was to analyse the duration required for formation of healthy granulation tissue, duration required for making wound fit for skin cover procedure and duration of hospital stay in compound open tibia fracture treated with vacuum assisted closure (VAC). Methods: A prospective interventional study of 22 patients aged 18 to 60 years was done. After assessing the size of the wound, primary bone fixation and wound debridement were carried out as soon as possible and then VAC was applied. Assessment of VAC therapy was based on mean decreases in wound size and \"modified Johner and Wruh's criteria\", used for assessment of the functional outcome of tibial shaft fracture was recorded during each follow-up. Results: Twenty two patients suffered comminuted open fractures of tibia-fibula. Primary fixation of bone were done with vacuum dressing. During follow-up, the good decrease in wound size considering vacuum dressing remedy was once 18.75 ± 18.36 cm2 (p = 0.001). Six patients achieved excellent results according to \"modified Johner and Wruh's criteria\" of tibial shaft fracture. Conclusion: This technique effectively reduced wound size, accelerated the formation of healthy granulation tissue of wound with open fracture bone and provided a better functional outcome. The VAC treatment had suggestively increased wound closure rate, decreased morbidity and costs for patients.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74201228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5937/scriptamed54-43142
S. Stoisavljević-Šatara, N. Stojaković, Ana Golić-Jelić, Ž. Maksimović, Milica Gajić-Bojić, Snežana Petrović-Tepić
Background/Aim: Clinical research nursing is a well-known concept in Europe and other countries. The purpose of this study was to investigate the nurses' knowledge and attitudes towards clinical research and their opinions and self-evaluation about clinical research nursing and factors affecting them. Methods: A cross sectional study was conducted at the University Clinical Centre of the Republic of Srpska (UCCRS). A questionnaire included 50 questions/ statements was created in order to address the aims of the research and afterwards distributed to 120 nurses from 6 departments. Results: Response rate was 91.6 %. Most of the respondents showed a low level of knowledge, but positive attitude related to clinical research. Nurses who participated in clinical research were confident in their competencies according to their self-evaluation. Conclusion: Systematic approach to the additional nurses education could have a significant impact on a success of clinical research.
{"title":"Knowledge, attitudes and nursing self-evaluation related to clinical research","authors":"S. Stoisavljević-Šatara, N. Stojaković, Ana Golić-Jelić, Ž. Maksimović, Milica Gajić-Bojić, Snežana Petrović-Tepić","doi":"10.5937/scriptamed54-43142","DOIUrl":"https://doi.org/10.5937/scriptamed54-43142","url":null,"abstract":"Background/Aim: Clinical research nursing is a well-known concept in Europe and other countries. The purpose of this study was to investigate the nurses' knowledge and attitudes towards clinical research and their opinions and self-evaluation about clinical research nursing and factors affecting them. Methods: A cross sectional study was conducted at the University Clinical Centre of the Republic of Srpska (UCCRS). A questionnaire included 50 questions/ statements was created in order to address the aims of the research and afterwards distributed to 120 nurses from 6 departments. Results: Response rate was 91.6 %. Most of the respondents showed a low level of knowledge, but positive attitude related to clinical research. Nurses who participated in clinical research were confident in their competencies according to their self-evaluation. Conclusion: Systematic approach to the additional nurses education could have a significant impact on a success of clinical research.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81400405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5937/scriptamed54-43703
P. Kovačević
Critical care medicine as relatively young discipline, started developing in mid1950s in response to epidemy of poliomyelitis. This branch of medicine evolved much faster in high-income countries (HIC) than in low resource settings (LRS) where the Republic of Srpska (Western Balkan) belongs. The experience of setting up a modern critical care program under the LRS constraints as a promising way forward to meet the increased demand for critical care worldwide is described. Main tool was systematic analysis of written documents related to the establishment of the first multidisciplinary MICU and its development to the present day. Successful development is contingent on formal education and continued mentorship from HIC, establishment of a multidisciplinary team, the support from local healthcare authorities, development of a formal subspecialty training, academic faculty development and research. Critical care medicine is a critical public health need in HIC and LRS alike.
{"title":"Development of critical care medicine in post-war Republic of Srpska: Banja Luka region","authors":"P. Kovačević","doi":"10.5937/scriptamed54-43703","DOIUrl":"https://doi.org/10.5937/scriptamed54-43703","url":null,"abstract":"Critical care medicine as relatively young discipline, started developing in mid1950s in response to epidemy of poliomyelitis. This branch of medicine evolved much faster in high-income countries (HIC) than in low resource settings (LRS) where the Republic of Srpska (Western Balkan) belongs. The experience of setting up a modern critical care program under the LRS constraints as a promising way forward to meet the increased demand for critical care worldwide is described. Main tool was systematic analysis of written documents related to the establishment of the first multidisciplinary MICU and its development to the present day. Successful development is contingent on formal education and continued mentorship from HIC, establishment of a multidisciplinary team, the support from local healthcare authorities, development of a formal subspecialty training, academic faculty development and research. Critical care medicine is a critical public health need in HIC and LRS alike.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86637447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5937/scriptamed54-44639
Mehmet Yilmaz, Gökhan Çil
Background/Aim: Urinary system stone disease develops with a frequency of 1-20 % in the general population. There are various surgical methods and percutaneous nephrolithotomy (PCNL) is a commonly used treatment method, especially in large, staghorn kidney stones. Aim of this study was compare stone nomograms in forecasting operative and complicating parameters subsequent to PCNL in staghorn stones. Methods: The study analysed 66 patients with staghorn stones who underwent PCNL between 2017 and 2022, retrospectively. The researcher evaluated the Guy, S.T.O.N.E. and CROSS nephrolithotomy scores in patients using non-contrast computed tomography. The Clavien Dindo Classification was used to evaluate the surgical complication. Results: The mean stone burden, GUY, S.T.O.N.E. and CROES scores were 1114.9 ± 520.18 mm²; 3.64 ± 0.48; 10.11 ± 1.2 and 142.9 ± 31.99, respectively. Total stone-free status (SFS) was achieved in 37.9 % of the patients, while the median stone clearance rate was 93.74 (50-100). While no statistical significance was observed between GUY score and SFS, it was observed in S.T.O.N.E. and CROES scores (p = 0.020 and 0.004, respectively). ROC analysis showed that CROES and S.T.O.N.E. scoring systems and the stone burden parameter showed similar accuracy in the estimation of SFS. The results showed that only the S.T.O.N.E. score showed a significant relationship with the presence of complications (p = 0.034). Conclusion: If the percutaneous nephrolithotomy for staghorn stones in question is, current scoring systems alone couldn't be predictive for postoperative outcomes and degree of complications. Further large scale multicentre prospective studies are needful.
{"title":"Evaluation of nephrolithometric scoring systems to predict outcomes and complications of percutaneous nephrolithotomy for staghorn stone","authors":"Mehmet Yilmaz, Gökhan Çil","doi":"10.5937/scriptamed54-44639","DOIUrl":"https://doi.org/10.5937/scriptamed54-44639","url":null,"abstract":"Background/Aim: Urinary system stone disease develops with a frequency of 1-20 % in the general population. There are various surgical methods and percutaneous nephrolithotomy (PCNL) is a commonly used treatment method, especially in large, staghorn kidney stones. Aim of this study was compare stone nomograms in forecasting operative and complicating parameters subsequent to PCNL in staghorn stones. Methods: The study analysed 66 patients with staghorn stones who underwent PCNL between 2017 and 2022, retrospectively. The researcher evaluated the Guy, S.T.O.N.E. and CROSS nephrolithotomy scores in patients using non-contrast computed tomography. The Clavien Dindo Classification was used to evaluate the surgical complication. Results: The mean stone burden, GUY, S.T.O.N.E. and CROES scores were 1114.9 ± 520.18 mm²; 3.64 ± 0.48; 10.11 ± 1.2 and 142.9 ± 31.99, respectively. Total stone-free status (SFS) was achieved in 37.9 % of the patients, while the median stone clearance rate was 93.74 (50-100). While no statistical significance was observed between GUY score and SFS, it was observed in S.T.O.N.E. and CROES scores (p = 0.020 and 0.004, respectively). ROC analysis showed that CROES and S.T.O.N.E. scoring systems and the stone burden parameter showed similar accuracy in the estimation of SFS. The results showed that only the S.T.O.N.E. score showed a significant relationship with the presence of complications (p = 0.034). Conclusion: If the percutaneous nephrolithotomy for staghorn stones in question is, current scoring systems alone couldn't be predictive for postoperative outcomes and degree of complications. Further large scale multicentre prospective studies are needful.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135839504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Aim: Although ferritin and haemoglobin were well-studied for adverse outcome prediction in COVID-19 patients, a ferritin-haemoglobin ratio (FHR) was studied poorly. The study aimed to evaluate the prognostic ability of FHR at hospital admission in hypertensive and non-hypertensive patients with COVID-19. Methods: The study included 135 patients hospitalised for COVID-19-associated pneumonia. The 78.5 % of patients were hypertensive. Results: FHR at admission was higher in patients with critical condition (39.8 [17.1-83.0]) than in patients with moderate (22.0 [12.1-32.1], p = 0.01) and severe condition (34.6 [15.1-64.5], p = 0.01). FHR was higher in patients who required supplemental oxygen (40.4 [29.4-47.8]) than in patients without the need for supplemental oxygen (22.0 [18.0-25.5]) (p = 0.001). FHR at admission was higher in non-survivors (40.1 [24.6-95.9]) than in survivors (24.5 [21.6-28.4]) (p = 0.047). FHR showed weak discriminative ability for the prediction of severe/critical conditions in hypertensive patients (AUC = 0.636, p = 0.015) and all (hypertensive and non-hypertensive patients) patients (AUC = 0.658, p = 0.001), whereas FHR had an acceptable discriminative ability in non-hypertensive patients (AUC = 0.764, p = 0.015). There was an acceptable discriminative ability of FHR for in-hospital mortality prediction in hypertensive patients (AUC = 0.717, p = 0.029). Patients with FHR > 33.98 (Youden index, 0.39) had higher odds of severe/critical clinical condition (OR: 4.57; 95 % CI: 1.87-11.18; p = 0.001). FHR of > 37.64 (Youden index, 0.55) was associated with higher in-hospital mortality among hypertensive patients (OR: 12.06; 95 % CI: 2.44-59.71; p = 0.002). There was no difference in AUC for the discriminative ability of FHR regarding severe/ critical condition (p = 0.296) and mortality (p = 0.663) in hypertensive and non-hypertensive patients. Conclusion: FHR at admission of > 33.98 is a predictor of severe/critical COVID-19 in both hypertensive and non-hypertensive patients. FHR of > 37.64 is a predictor of in-hospital mortality in hypertensive patients. There was no significant difference in the discriminative ability of FHR between hypertensive and non-hypertensive patients.
{"title":"Ferritin-haemoglobin ratio as a predictor of severity and fatal outcome in patients with Covid-19","authors":"Oleksiy Skakun, Nestor Seredyuk, Sergiy Fedorov, Olha Verbovska","doi":"10.5937/scriptamed54-45157","DOIUrl":"https://doi.org/10.5937/scriptamed54-45157","url":null,"abstract":"Background/Aim: Although ferritin and haemoglobin were well-studied for adverse outcome prediction in COVID-19 patients, a ferritin-haemoglobin ratio (FHR) was studied poorly. The study aimed to evaluate the prognostic ability of FHR at hospital admission in hypertensive and non-hypertensive patients with COVID-19. Methods: The study included 135 patients hospitalised for COVID-19-associated pneumonia. The 78.5 % of patients were hypertensive. Results: FHR at admission was higher in patients with critical condition (39.8 [17.1-83.0]) than in patients with moderate (22.0 [12.1-32.1], p = 0.01) and severe condition (34.6 [15.1-64.5], p = 0.01). FHR was higher in patients who required supplemental oxygen (40.4 [29.4-47.8]) than in patients without the need for supplemental oxygen (22.0 [18.0-25.5]) (p = 0.001). FHR at admission was higher in non-survivors (40.1 [24.6-95.9]) than in survivors (24.5 [21.6-28.4]) (p = 0.047). FHR showed weak discriminative ability for the prediction of severe/critical conditions in hypertensive patients (AUC = 0.636, p = 0.015) and all (hypertensive and non-hypertensive patients) patients (AUC = 0.658, p = 0.001), whereas FHR had an acceptable discriminative ability in non-hypertensive patients (AUC = 0.764, p = 0.015). There was an acceptable discriminative ability of FHR for in-hospital mortality prediction in hypertensive patients (AUC = 0.717, p = 0.029). Patients with FHR > 33.98 (Youden index, 0.39) had higher odds of severe/critical clinical condition (OR: 4.57; 95 % CI: 1.87-11.18; p = 0.001). FHR of > 37.64 (Youden index, 0.55) was associated with higher in-hospital mortality among hypertensive patients (OR: 12.06; 95 % CI: 2.44-59.71; p = 0.002). There was no difference in AUC for the discriminative ability of FHR regarding severe/ critical condition (p = 0.296) and mortality (p = 0.663) in hypertensive and non-hypertensive patients. Conclusion: FHR at admission of > 33.98 is a predictor of severe/critical COVID-19 in both hypertensive and non-hypertensive patients. FHR of > 37.64 is a predictor of in-hospital mortality in hypertensive patients. There was no significant difference in the discriminative ability of FHR between hypertensive and non-hypertensive patients.","PeriodicalId":33497,"journal":{"name":"Scripta Medica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135839510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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