D. Hadžić, Evlijana Zulić, Dženana Ostrvica, Amel Selimović, M. Ćurčić
Introduction: Standing advances in neonatology increased survival of premature infants with the use of invasive procedures, which increases risk of infection and fungal sepsis. Risk factors for fungal sepsis are extensively studied. Candida is dominant, but there is increase in resistant C. non-albicans species. Mortality is high and requires timely suspicion of fungal sepsis, and adequate treatment to counteract the fatal outcome.Objectives: To analyze the clinical and laboratory characteristics of neonates, treated in the neonatal intensive care unit because of microbiologically proven fungal sepsis.Subjects and Methods:The restrospective observational study included 48 consecutive neonates, treated in Iintensive care unit of Pediatric Clinic Tuzla during three-year period (2016-2018), those with proven fungal sepsis, confirmed by positive blood culture. We analyzed perinatal history, clinical and laboratory presentation of disease, length of treatment and outcome. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution.Results: Of the total treated 921 neonates, confirmed fungal sepsis were found in 48 infants (5.2%), evenly distributed by gender. Of perinatal risk factors, confirmed the prematurity and low birth weight, and significant were the presence of umbilical venous catheter, parenteral nutrition, longer antibiotic therapy and mechanical ventilation. Clinically, fungal sepsis manifested as late sepsis with respiratory higher requirements, lethargy, feeding difficulties and abdominal distension. The most common laboratory abnormalities were increased CRP, leukocytosis and thrombocytopenia. Outcome: 44 neonates (91.7%) survived, while 4 neonates (8.3%) died. Antifungal therapy lasted 20.6 ± 6 days, and intensive treatment 38.2 ± 23.2 days. All isolates were Candida species, in vitro without resistance. In 8 neonates (16.7%) recorded a slight toxic hepatitis.Conclusion: Recovery of neonates with fungal sepsis depend on timely clinical suspicion, adequate treatment and monitoring. Antifungal susceptibility is also important, which requires monitoring of local epidemiological data to improve treatment.
{"title":"Epidemiology and clinical presentation of neonatal fungal sepsis in intensive care units of Pediatric clinic Tuzla","authors":"D. Hadžić, Evlijana Zulić, Dženana Ostrvica, Amel Selimović, M. Ćurčić","doi":"10.5457/ams.v49i2.516","DOIUrl":"https://doi.org/10.5457/ams.v49i2.516","url":null,"abstract":"Introduction: Standing advances in neonatology increased survival of premature infants with the use of invasive procedures, which increases risk of infection and fungal sepsis. Risk factors for fungal sepsis are extensively studied. Candida is dominant, but there is increase in resistant C. non-albicans species. Mortality is high and requires timely suspicion of fungal sepsis, and adequate treatment to counteract the fatal outcome.Objectives: To analyze the clinical and laboratory characteristics of neonates, treated in the neonatal intensive care unit because of microbiologically proven fungal sepsis.Subjects and Methods:The restrospective observational study included 48 consecutive neonates, treated in Iintensive care unit of Pediatric Clinic Tuzla during three-year period (2016-2018), those with proven fungal sepsis, confirmed by positive blood culture. We analyzed perinatal history, clinical and laboratory presentation of disease, length of treatment and outcome. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution.Results: Of the total treated 921 neonates, confirmed fungal sepsis were found in 48 infants (5.2%), evenly distributed by gender. Of perinatal risk factors, confirmed the prematurity and low birth weight, and significant were the presence of umbilical venous catheter, parenteral nutrition, longer antibiotic therapy and mechanical ventilation. Clinically, fungal sepsis manifested as late sepsis with respiratory higher requirements, lethargy, feeding difficulties and abdominal distension. The most common laboratory abnormalities were increased CRP, leukocytosis and thrombocytopenia. Outcome: 44 neonates (91.7%) survived, while 4 neonates (8.3%) died. Antifungal therapy lasted 20.6 ± 6 days, and intensive treatment 38.2 ± 23.2 days. All isolates were Candida species, in vitro without resistance. In 8 neonates (16.7%) recorded a slight toxic hepatitis.Conclusion: Recovery of neonates with fungal sepsis depend on timely clinical suspicion, adequate treatment and monitoring. Antifungal susceptibility is also important, which requires monitoring of local epidemiological data to improve treatment. ","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47611480","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}
S. Grgic, Linda Soldo Čorić, Vesna Antunović Skelo, S. Kukić, H. B. Ivanković, Ž. Sulaver, Belma Gazibera
Introduction: Inflammatory fibroblast tumor is rare tumor that most often occurs in younger people, usually 30 years old or younger, but most commonly in children age 6-10 years. It usually affects gastrointestinal tract and the lungs but it can also occur in several places at the same time. Clinical manifestations vary depending of the affected system of the body so it is very difficult to determine diagnosis without surgical extirpation and patohistological analysis. Complete surgical resection is curative in most patients and recidivism is rare. Liver abscesses more common occur in females with risk factors and medical history of diabetes, previous liver disease and less likely in patients with granulomatous diseases. Liver abscesses mortality in developing countries is 2-12%, increasing due to open surgical drainage.Case report: We present a 35 years-old patient who was treated at the Clinic for Infectious Diseases University Hospital Mostar and University Hospital Sarajevo, Clinic for Infectious Diseases in August and September 2018 and Clinical Hospital Merkur, Zagreb Surgery Clinic in December 2018. Data was used from medical documentation. Young, immunocompetent patient who was addmited to a hospital following high fever, chills and poor general condition was diagnosed with multiple focal necrotic lesions, differential-diagnostically most likely liver and spleen abscesses with high suspicion of liver malignancy. Liver biopsy was performed and patohistological analysis confirmed the diagnosis of multiple liver abscesses in the IV and VI liver segment, and inflamatory fibroblast tumor in the IV liver segment. Eight weeks of conservative treatment resulted in a complete regression of liver abscesses and inflamatory fibroblast tumor was surgically extirpated at the Clinic Hospital Merkur, Surgery Clinic in the Zagreb in December 2018.Conclusion: An approach to a patient with a multiple liver abscesses and liver tumor requires sub-specialists experience and urgent multidisciplinary diagnostic and treatment approach to prevent further complications and deadly outcome.
{"title":"Inflamatory fibroblast tumor and liver abscesses in the young patient","authors":"S. Grgic, Linda Soldo Čorić, Vesna Antunović Skelo, S. Kukić, H. B. Ivanković, Ž. Sulaver, Belma Gazibera","doi":"10.5457/ams.v49i0.521","DOIUrl":"https://doi.org/10.5457/ams.v49i0.521","url":null,"abstract":"Introduction: Inflammatory fibroblast tumor is rare tumor that most often occurs in younger people, usually 30 years old or younger, but most commonly in children age 6-10 years. It usually affects gastrointestinal tract and the lungs but it can also occur in several places at the same time. Clinical manifestations vary depending of the affected system of the body so it is very difficult to determine diagnosis without surgical extirpation and patohistological analysis. Complete surgical resection is curative in most patients and recidivism is rare. Liver abscesses more common occur in females with risk factors and medical history of diabetes, previous liver disease and less likely in patients with granulomatous diseases. Liver abscesses mortality in developing countries is 2-12%, increasing due to open surgical drainage.Case report: We present a 35 years-old patient who was treated at the Clinic for Infectious Diseases University Hospital Mostar and University Hospital Sarajevo, Clinic for Infectious Diseases in August and September 2018 and Clinical Hospital Merkur, Zagreb Surgery Clinic in December 2018. Data was used from medical documentation. Young, immunocompetent patient who was addmited to a hospital following high fever, chills and poor general condition was diagnosed with multiple focal necrotic lesions, differential-diagnostically most likely liver and spleen abscesses with high suspicion of liver malignancy. Liver biopsy was performed and patohistological analysis confirmed the diagnosis of multiple liver abscesses in the IV and VI liver segment, and inflamatory fibroblast tumor in the IV liver segment. Eight weeks of conservative treatment resulted in a complete regression of liver abscesses and inflamatory fibroblast tumor was surgically extirpated at the Clinic Hospital Merkur, Surgery Clinic in the Zagreb in December 2018.Conclusion: An approach to a patient with a multiple liver abscesses and liver tumor requires sub-specialists experience and urgent multidisciplinary diagnostic and treatment approach to prevent further complications and deadly outcome. ","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47465628","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}
Irma Salimović Bešić, Adna Kahriman, S. Arapčić, A. Ljubović
Background: Hepatitis C virus (HCV) genotypes and subtypes exhibit significant geographic variations.Aim: To analyse the distribution of genotypes/subtypes of HCV in a group of patients with chronic hepatitis C from Canton Sarajevo during 2012-2018.Material and methods:The study enrolled 247 human plasma samples of HCV-RNA positive patients with available results of HCV genotyping test.Results: During 2012-2018, the domination of subtypes 1a (34.01%), 1b (28.34%) and genotype 3 (23.89%) was registered. In 2012 and 2013, HCV subtype 1a was the most common (27/63; 42.86% and 17/40; 42.50%, respectively). In 2014, the leading HCV genotype/subtype were 3 and 1b (17/57; 29.82%). In 2015, the dominance of HCV genotype 3 (14/39; 35.90%) continued, while in 2016, the same number of HCV subtypes 1a and 1b (11/30; 36.67%) was recorded. Although in a small number of tested, during 2017, HCV subtype 1b was the most prevalent (7/14; 50.00%), and in 2018, it was replaced by a HCV subtype 1a (3/4; 75.00%). Distribution of HCV genotypes/subtypes by age group of patients varied significantly (p=0.000). The largest number of patients (71/247; 28.74%) belonged to the age category 30-39 years and HCV genotypes/subtypes 1, 3, 4, 1a and 1b were identified. Except in 2017, male gender significantly dominated (p=0.000). In males, HCV subtype 1a (68/170; 40.00%) was the most common, while in women it was HCV subtype 1b (44/77; 57.14%).Conclusion: This six-year retrospective study showed the time variations of the circulating HCV genotypes/subtypes among patients with chronic hepatitis C in Canton Sarajevo. Genotyping of the HCV has an important implications for diagnosis and treatment of the patients.
{"title":"Distribution of hepatitis C virus genotypes and subtypes in a group of patients with chronic hepatitis C from Canton Sarajevo, 2012-2018","authors":"Irma Salimović Bešić, Adna Kahriman, S. Arapčić, A. Ljubović","doi":"10.5457/ams.v49i0.524","DOIUrl":"https://doi.org/10.5457/ams.v49i0.524","url":null,"abstract":"Background: Hepatitis C virus (HCV) genotypes and subtypes exhibit significant geographic variations.Aim: To analyse the distribution of genotypes/subtypes of HCV in a group of patients with chronic hepatitis C from Canton Sarajevo during 2012-2018.Material and methods:The study enrolled 247 human plasma samples of HCV-RNA positive patients with available results of HCV genotyping test.Results: During 2012-2018, the domination of subtypes 1a (34.01%), 1b (28.34%) and genotype 3 (23.89%) was registered. In 2012 and 2013, HCV subtype 1a was the most common (27/63; 42.86% and 17/40; 42.50%, respectively). In 2014, the leading HCV genotype/subtype were 3 and 1b (17/57; 29.82%). In 2015, the dominance of HCV genotype 3 (14/39; 35.90%) continued, while in 2016, the same number of HCV subtypes 1a and 1b (11/30; 36.67%) was recorded. Although in a small number of tested, during 2017, HCV subtype 1b was the most prevalent (7/14; 50.00%), and in 2018, it was replaced by a HCV subtype 1a (3/4; 75.00%). Distribution of HCV genotypes/subtypes by age group of patients varied significantly (p=0.000). The largest number of patients (71/247; 28.74%) belonged to the age category 30-39 years and HCV genotypes/subtypes 1, 3, 4, 1a and 1b were identified. Except in 2017, male gender significantly dominated (p=0.000). In males, HCV subtype 1a (68/170; 40.00%) was the most common, while in women it was HCV subtype 1b (44/77; 57.14%).Conclusion: This six-year retrospective study showed the time variations of the circulating HCV genotypes/subtypes among patients with chronic hepatitis C in Canton Sarajevo. Genotyping of the HCV has an important implications for diagnosis and treatment of the patients.","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43442526","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}
F. Numanović, J. Smajlović, Elsada Čičko, Z. Delibegović, Merima Gegić, Hanka Kikanović, A. Bećirović, E. Halilović, Mubera Kutlovac, Indira Džanić
Background: Colonization is the presence of bacteria in the intestines, skin, nose, throat or anywhere in the human body without any signs of infection but with increased risk for spreading bacteria to other patients and the emergence of new infections. Screening of colonized patients is used as part of the prevention and control of multidrug-resistant (MDR) infections caused by agents such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis and multi-resistant Gram-negative bacteria. Material and methods: Data from 169 screened respondents hospitalized at the University Clinical Center Tuzla, between October 1, 2018, and May 1, 2019, were analyzed. Swabs were taken from nostrils, throat, axilla and groin area for all patients, and also from the anorectal area for 157 of them. Identification of MDR bacteria was done by phenotypical methods, according to the recommendations of EUCAST Clinical Breakpoint Table v.8.0, 2018. Results: Out of 169 patients, negative screening test results were found in 93 examinees (55.02%), and positive in 76 (44.97%). The largest number of patients undergoing screening was hospitalized in the Intensive Care Unit (Surgical Block), 73/169 (43.19%). The average screening time was 2.2 days or 53 hours. In 18/76 (23.68%) of patients with positive screening, prior to screening regular microbiological testing was done, and in the remaining 58/76 (76.3%) screening was performed first. Analyzing respondents with positive screening, 27 (35.53%) had negative findings during regular microbiological testing of different biological samples and for 49 (64.47%) different/same strains of MDR bacteria were isolated.Conclusion: Knowing the phenotypic profile of bacteria colonizing patients in intensive care units is a very useful tool in preventing their spread intra- and inter-hospitals.
{"title":"Importance of screening in the prevention of emergence and spread of MDR bacteria","authors":"F. Numanović, J. Smajlović, Elsada Čičko, Z. Delibegović, Merima Gegić, Hanka Kikanović, A. Bećirović, E. Halilović, Mubera Kutlovac, Indira Džanić","doi":"10.5457/ams.v49i0.522","DOIUrl":"https://doi.org/10.5457/ams.v49i0.522","url":null,"abstract":"Background: Colonization is the presence of bacteria in the intestines, skin, nose, throat or anywhere in the human body without any signs of infection but with increased risk for spreading bacteria to other patients and the emergence of new infections. Screening of colonized patients is used as part of the prevention and control of multidrug-resistant (MDR) infections caused by agents such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis and multi-resistant Gram-negative bacteria. Material and methods: Data from 169 screened respondents hospitalized at the University Clinical Center Tuzla, between October 1, 2018, and May 1, 2019, were analyzed. Swabs were taken from nostrils, throat, axilla and groin area for all patients, and also from the anorectal area for 157 of them. Identification of MDR bacteria was done by phenotypical methods, according to the recommendations of EUCAST Clinical Breakpoint Table v.8.0, 2018. Results: Out of 169 patients, negative screening test results were found in 93 examinees (55.02%), and positive in 76 (44.97%). The largest number of patients undergoing screening was hospitalized in the Intensive Care Unit (Surgical Block), 73/169 (43.19%). The average screening time was 2.2 days or 53 hours. In 18/76 (23.68%) of patients with positive screening, prior to screening regular microbiological testing was done, and in the remaining 58/76 (76.3%) screening was performed first. Analyzing respondents with positive screening, 27 (35.53%) had negative findings during regular microbiological testing of different biological samples and for 49 (64.47%) different/same strains of MDR bacteria were isolated.Conclusion: Knowing the phenotypic profile of bacteria colonizing patients in intensive care units is a very useful tool in preventing their spread intra- and inter-hospitals.","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48408894","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}
The treatment of respiratory failure has seen progress since the early nineties. The development of noninvasive ventilation (NIV) provides new possibilities for better treatment and risk reduction. To achieve the therapeutic success of NIV and the reduction in incidence of complications, one must have knowledge of clinical indications and contraindications, the appropriate choice of ventilation modes and ventilation delivery equipment, close monitoring, and ventilation need to be started timely. The development of new technologies has expanded the indications for the use of NIV in children. Of particular importance is the clinical assessment of each patient, a good knowledge of the potential risks for failure of NIV, and creating a written local protocols for the NIV treatment in every health facility where this ventilation technique is applied.
{"title":"Noninvasive Ventilation in Children","authors":"D. Hadžić","doi":"10.5457/ams.v49i1.488","DOIUrl":"https://doi.org/10.5457/ams.v49i1.488","url":null,"abstract":"The treatment of respiratory failure has seen progress since the early nineties. The development of noninvasive ventilation (NIV) provides new possibilities for better treatment and risk reduction. To achieve the therapeutic success of NIV and the reduction in incidence of complications, one must have knowledge of clinical indications and contraindications, the appropriate choice of ventilation modes and ventilation delivery equipment, close monitoring, and ventilation need to be started timely. The development of new technologies has expanded the indications for the use of NIV in children. Of particular importance is the clinical assessment of each patient, a good knowledge of the potential risks for failure of NIV, and creating a written local protocols for the NIV treatment in every health facility where this ventilation technique is applied.","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45638218","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}
E. Jusufovic, M. Košnik, J. Nurkić, N. Arifhodzic, M. Al‐Ahmad, L. B. Kardum, M. Bećarević, M. Osmić, Azra Jusufovic, Dženan Halilović, R. Sejdinović, Sanja Brekalo Lazarević, B. Prnjavorac
Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advanced chronic obstructive pulmonary disease (COPD). Induction of sputum requires expertise and may not always be successful. Aim was to investigate correlation and predictive relationship between peripheral blood eosinophils (bEo) and sputum eosinophils (sEo), and impact of peripheral blood eosinophilia on outcome of COPD exacerbation. 120 current smokers with COPD (GOLD group C) (57.4 ± 0.92 years, M/F ratio 1.4), with no blood (≥7% or >0.43x109/L) nor sputum (≥3%) eosinophilia, were treated with moderate dose of ICS and long-acting bronchodilatator during stable disease, but systemic corticosteroids and antibiotics during exacerbation. According to sputum eosinophilia (≥4%) during exacerbation, patients were divided into eosinophilic (n=45) and non-eosinophilic group (n=75). In stable disease, bEo and sEo were similar in both groups (p>0.05). During exacerbation, bEo and sEo were significantly higher in eosinophilic group (eosinophilic vs. non-eosinophilic: blood: 1.42 ± 0.39 x109/l vs. 0.23 ± 0.02 x109/l, p<0.001; sputum: 8% (4, 19) vs. 1% (0, 3), p<0.0001), but bEo correlated with sEo in both groups (eosinophilic: r=0.52, p<0.001; non-eosinophilic: r=0.25, p<0.05). Relative bEo predicted sputum eosinophilia (area under the curve=0.71, standard error=0.05; 95% confidence interval [CI] =0.61-0.81; p<0.001) and enabled identification of the presence or absence of sputum eosinophilia in 82% of the cases at a threshold of ≥4% (specificity=83.56%, sensitivity=93.83%, positive likelihood ratio=3.67). Eosinophilic group during exacerbation showed less frequent hospitalisations and shorter exacerbation (eosinophilic vs. non-eosinophilic: hospitalisations: 26.7% vs. 60.0%, p<0.001; duration of exacerbation (days): 8.1±0.35 vs. 10.13±0.31, p<0.0001). In COPD exacerbation, relative peripheral blood eosinophils ≥4% might identify sputum eosinophilia. Blood eosinophilia indicate better outcome of COPD exacerbation. Further investigations are needed to predict eosinophilic exacerbation in COPD patients, with prior absence of sputum or blood eosinophilia.
{"title":"Peripheral Blood Eosinophils as Marker of Sputum Eosinophilia and Outcome of COPD Exacerbation","authors":"E. Jusufovic, M. Košnik, J. Nurkić, N. Arifhodzic, M. Al‐Ahmad, L. B. Kardum, M. Bećarević, M. Osmić, Azra Jusufovic, Dženan Halilović, R. Sejdinović, Sanja Brekalo Lazarević, B. Prnjavorac","doi":"10.5457/ams.v49i1.487","DOIUrl":"https://doi.org/10.5457/ams.v49i1.487","url":null,"abstract":"Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advanced chronic obstructive pulmonary disease (COPD). Induction of sputum requires expertise and may not always be successful. Aim was to investigate correlation and predictive relationship between peripheral blood eosinophils (bEo) and sputum eosinophils (sEo), and impact of peripheral blood eosinophilia on outcome of COPD exacerbation. 120 current smokers with COPD (GOLD group C) (57.4 ± 0.92 years, M/F ratio 1.4), with no blood (≥7% or >0.43x109/L) nor sputum (≥3%) eosinophilia, were treated with moderate dose of ICS and long-acting bronchodilatator during stable disease, but systemic corticosteroids and antibiotics during exacerbation. According to sputum eosinophilia (≥4%) during exacerbation, patients were divided into eosinophilic (n=45) and non-eosinophilic group (n=75). In stable disease, bEo and sEo were similar in both groups (p>0.05). During exacerbation, bEo and sEo were significantly higher in eosinophilic group (eosinophilic vs. non-eosinophilic: blood: 1.42 ± 0.39 x109/l vs. 0.23 ± 0.02 x109/l, p<0.001; sputum: 8% (4, 19) vs. 1% (0, 3), p<0.0001), but bEo correlated with sEo in both groups (eosinophilic: r=0.52, p<0.001; non-eosinophilic: r=0.25, p<0.05). Relative bEo predicted sputum eosinophilia (area under the curve=0.71, standard error=0.05; 95% confidence interval [CI] =0.61-0.81; p<0.001) and enabled identification of the presence or absence of sputum eosinophilia in 82% of the cases at a threshold of ≥4% (specificity=83.56%, sensitivity=93.83%, positive likelihood ratio=3.67). Eosinophilic group during exacerbation showed less frequent hospitalisations and shorter exacerbation (eosinophilic vs. non-eosinophilic: hospitalisations: 26.7% vs. 60.0%, p<0.001; duration of exacerbation (days): 8.1±0.35 vs. 10.13±0.31, p<0.0001). In COPD exacerbation, relative peripheral blood eosinophils ≥4% might identify sputum eosinophilia. Blood eosinophilia indicate better outcome of COPD exacerbation. Further investigations are needed to predict eosinophilic exacerbation in COPD patients, with prior absence of sputum or blood eosinophilia.","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44490463","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}
M. Bećarević, Alma Dizdarevic, Zulfo Ahmetović, Amila Mujezinović, Esed Omerkić
Background: People with intellectual disability, have been shown to become high and frequent users of primary health care services—both general population health professionals and intellectual disability specialists. Aim: The aim of this paper has been to assess differences of Health and Safety Activities children with intellectual disabilities on the Supports Intensity Scale-Children’s Version and to confirm assumptions that support needs are confounded with age, IQ andgender.Methods:The sample included 377 children with intellectual disabilities in Bosnia and Herzegovina aged 5-16. Most respondents also had the presence of other, concurrent conditions and disorders. Using IQ, the sample was equalized to the level of intellectual functioning, and this data was obtained from the findings and opinions of the Commission for the Categorization of Children with Special Needs.Results:It was found at the multivariate level there are statistically significant differences between respondents of different ages and IQ in values of type, frequency and time of duration of support. No significant differences between boys and girls were identified at the multivariate level. Healthcare professionals and intellectual disability specialists must work as a team to guarantee any person with intellectual disability possibility to come as close as possible to the standard levels of well-being and health-related quality of life of the general population.
{"title":"Health and Safety Issues in Children with Intellectual Disability","authors":"M. Bećarević, Alma Dizdarevic, Zulfo Ahmetović, Amila Mujezinović, Esed Omerkić","doi":"10.5457/ams.v49i1.490","DOIUrl":"https://doi.org/10.5457/ams.v49i1.490","url":null,"abstract":"Background: People with intellectual disability, have been shown to become high and frequent users of primary health care services—both general population health professionals and intellectual disability specialists. Aim: The aim of this paper has been to assess differences of Health and Safety Activities children with intellectual disabilities on the Supports Intensity Scale-Children’s Version and to confirm assumptions that support needs are confounded with age, IQ andgender.Methods:The sample included 377 children with intellectual disabilities in Bosnia and Herzegovina aged 5-16. Most respondents also had the presence of other, concurrent conditions and disorders. Using IQ, the sample was equalized to the level of intellectual functioning, and this data was obtained from the findings and opinions of the Commission for the Categorization of Children with Special Needs.Results:It was found at the multivariate level there are statistically significant differences between respondents of different ages and IQ in values of type, frequency and time of duration of support. No significant differences between boys and girls were identified at the multivariate level. Healthcare professionals and intellectual disability specialists must work as a team to guarantee any person with intellectual disability possibility to come as close as possible to the standard levels of well-being and health-related quality of life of the general population.","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41853984","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}
S. Manno, C. Capretti, T. Giudice, Olga Bisaccia, L. D. Atti
Rectal bleeding seen after a transrectal ultrasound-guided prostate biopsy is often mild and self-limiting. We report a rare case of delayed massive rectal bleeding, post transrectal ultrasound-guided biopsy, in a man in active surveillance for prostate carcinoma, without risk factors for bleeding. We managed this complication with a successfully angiographic embolization.We present this case in detail and we analyze the possible causes of this complication.
{"title":"A rare case of delayed massive rectal bleeding, after transrectal ultrasound- guided prostate biopsy, requiring a multidisciplinary approach treatment","authors":"S. Manno, C. Capretti, T. Giudice, Olga Bisaccia, L. D. Atti","doi":"10.5457/ams.v49i1.512","DOIUrl":"https://doi.org/10.5457/ams.v49i1.512","url":null,"abstract":"Rectal bleeding seen after a transrectal ultrasound-guided prostate biopsy is often mild and self-limiting. We report a rare case of delayed massive rectal bleeding, post transrectal ultrasound-guided biopsy, in a man in active surveillance for prostate carcinoma, without risk factors for bleeding. We managed this complication with a successfully angiographic embolization.We present this case in detail and we analyze the possible causes of this complication.","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45251299","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}
M. Vidović, A. Burina, O. Ibrahimagić, D. Smajlović
The aim of this study was to evaluate anosognosia in acute stroke phase in order to type of stroke (ischemia, hemorrhage) and stroke localization as well as post-stroke patients recovery. Subjects and methods: In this prospective analysis were included 191 patients (96 males and 95 females) with first-ever stroke who were treated at the Department of neurology of the University Clinical Center in Tuzla. All patients were tested to anosognosia presence in acute stroke phase according to the modified Bisiach scale (7), while the level of disability was assessed using the Rankin scale (8) and level of functioning in daily activities using the Barthel index (9). Re-testing was done in week five post-stroke. Results: The average age of patients was 66.41 (mean age 10.21). Ischemic stroke had 168 patients (88%) while 23 (12%) the hemorrhagic one. The lesions localized to the right hemisphere were in 111 (58.11%) patients as well as in 80 (41.89%) patients with lesions localized to the left hemisphere. Anosognosia with no statistical significance was verified in 28% of patients in acute stroke phase, more often caused by lesions to the right hemisphere. Otherwise, significantly more frequent anosognosia was present in patients with hemorrhagic stroke mostly caused by massive lesions localized to the right hemisphere. Conclusion: Presence of anosognosia in patients with stroke vitally influenced patient’s functional status in re-testing phase just as well as in the acute stroke phase.
{"title":"Anosognosia in acute stroke and functional recovery after stroke","authors":"M. Vidović, A. Burina, O. Ibrahimagić, D. Smajlović","doi":"10.5457/ams.v49i1.486","DOIUrl":"https://doi.org/10.5457/ams.v49i1.486","url":null,"abstract":"The aim of this study was to evaluate anosognosia in acute stroke phase in order to type of stroke (ischemia, hemorrhage) and stroke localization as well as post-stroke patients recovery. Subjects and methods: In this prospective analysis were included 191 patients (96 males and 95 females) with first-ever stroke who were treated at the Department of neurology of the University Clinical Center in Tuzla. All patients were tested to anosognosia presence in acute stroke phase according to the modified Bisiach scale (7), while the level of disability was assessed using the Rankin scale (8) and level of functioning in daily activities using the Barthel index (9). Re-testing was done in week five post-stroke. Results: The average age of patients was 66.41 (mean age 10.21). Ischemic stroke had 168 patients (88%) while 23 (12%) the hemorrhagic one. The lesions localized to the right hemisphere were in 111 (58.11%) patients as well as in 80 (41.89%) patients with lesions localized to the left hemisphere. Anosognosia with no statistical significance was verified in 28% of patients in acute stroke phase, more often caused by lesions to the right hemisphere. Otherwise, significantly more frequent anosognosia was present in patients with hemorrhagic stroke mostly caused by massive lesions localized to the right hemisphere. Conclusion: Presence of anosognosia in patients with stroke vitally influenced patient’s functional status in re-testing phase just as well as in the acute stroke phase.","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42337959","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}
The civil sector should identify an appropriate form of representation through which the interests of all categories of patients will be expressed. The easiest way to achieve this goal is through Supreme Patient Association consisted of representatives from registered associations whose legally confirmed purpose is the exercise of patients' rights. The Association mission must be the policy of protecting the rights of all patients and patients’ groups, while fulfillment of the obligation to protect the rights of the patients and the monitoring of the implementation of the Act would be its primary responsibility. The Initiative Committee should make an effort to gather representatives of existing patients’ associations and other stakeholders, and guide them to form the umbrella association. At the same time, there needs to be made a clear distinction in terms of difference in respect to roles of the future founder. In short, the tasks of this association can be divided into three areas: raising awareness; encouraging authorities to respect the principles of equal protection of patients' rights; and collecting data on the state of patient rights protection. In conclusion, it logically seems completely clear and justified: 1. existence of one supreme/umbrella association, 2. collection of relevant data in a methodologically correct manner by authorized bodies and from the entire territory for which the umbrella association was established; and 3. to inform the base on conclusions of analysies concernig particular issues - both for a specific location and for the entire territory (either the municipality; the canton; the federation).
{"title":"Association of Patients' Organisations in the federation of Bosnia and Herzegovina: Social Participation Concept","authors":"A. Pašić, Maida Mulić Šećerbegović, A. Novo","doi":"10.5457/ams.v49i1.481","DOIUrl":"https://doi.org/10.5457/ams.v49i1.481","url":null,"abstract":"The civil sector should identify an appropriate form of representation through which the interests of all categories of patients will be expressed. The easiest way to achieve this goal is through Supreme Patient Association consisted of representatives from registered associations whose legally confirmed purpose is the exercise of patients' rights. The Association mission must be the policy of protecting the rights of all patients and patients’ groups, while fulfillment of the obligation to protect the rights of the patients and the monitoring of the implementation of the Act would be its primary responsibility. The Initiative Committee should make an effort to gather representatives of existing patients’ associations and other stakeholders, and guide them to form the umbrella association. At the same time, there needs to be made a clear distinction in terms of difference in respect to roles of the future founder. In short, the tasks of this association can be divided into three areas: raising awareness; encouraging authorities to respect the principles of equal protection of patients' rights; and collecting data on the state of patient rights protection. In conclusion, it logically seems completely clear and justified: 1. existence of one supreme/umbrella association, 2. collection of relevant data in a methodologically correct manner by authorized bodies and from the entire territory for which the umbrella association was established; and 3. to inform the base on conclusions of analysies concernig particular issues - both for a specific location and for the entire territory (either the municipality; the canton; the federation).","PeriodicalId":53635,"journal":{"name":"Acta Medica Saliniana","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45416786","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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