Acta clinica Croatica最新文献

The aim of this study was to assess the case fatality ratio (CFR) in persons with multiple sclerosis (PwMS) hospitalized due to severe COVID-19, and to investigate the role of risk factors for fatal outcome in this well-defined cohort. This case series study included all PwMS (N=32) with severe COVID-19, who were hospitalized in the COVID-19 referral center in Belgrade from January 2021 to January 2022. Eight out of these 32 patients died from COVID-19 (CFR 25%). The cause of death was sepsis in 7 patients and pulmonary embolism in one patient. Results of univariate logistic regression analyses demonstrated that older age, EDSS higher than 6.0, progressive multiple sclerosis (MS) forms, cardiovascular comorbidities, and longer duration of hospital stay statistically significantly increased the risk of COVID-19-related death in MS patients. Treatment with ocrelizumab was associated with more than 2-fold increased death risk (p=0.408). Multivariate logistic regression analysis showed that progressive forms of MS (p=0.044) and longer hospitalization (p=0.006) significantly increased the risk of death in our MS cohort. In our study, older age, presence of comorbidities, and progressive disease course were independent predictors of increased lethality of COVID-19 in PwMS. More intense monitoring may be warranted in PwMS treated with anti-CD20 agents.

Acute ischemic stroke has an important place among emergency department admissions. After a rapid diagnosis of the patient admitted with a preliminary diagnosis of stroke, the necessary examination and first intervention should be performed, then diagnostic evaluation should be made. The aim of this study was to investigate whether paraoxonase-1 (PON-1) enzyme activity, measured in patients whose stroke onset is known, is a diagnostic biomarker for stroke by evaluating the relationship between stroke diagnosis, ischemic area volume, and stroke onset. The study included 100 patients over age 18 admitted to the emergency department with acute stroke symptoms, with known stroke onset and diagnosed as acute occlusive cerebrovascular disease within 24 hours, and 100 healthy control subjects. After initial evaluation, computed tomography of the brain and magnetic resonance imaging, PON-1 activity was measured by colorimetric method in patient serum. Comparison of PON-1 levels between the two groups yielded a statistically significant difference. There was a significant decrease in serum PON-1 values in patient group as compared with control group (p<0.001). According to these results, no significant relationship was found between the affected ischemic area of the brain, PON-1, and ischemic volume values. The possible relationship between PON-1 values and stroke onset was compared and no statistically significant difference was found (p=0.311). The relationship between PON-1 enzyme activity and diagnosis of acute ischemic stroke was found to be significant. PON-1 was found to be lower in stroke patients but no correlation was found with ischemic area volume.

The aim of our 5-year study (from January 2008 to December 2012) was to compare the incidence of peptic ulcer bleeding (PUB) to bleeding from tumors of the upper gastrointestinal tract. The percentage of re-bleeding within the first 30 days of hospital admission, as well as the need of blood transfusions, are also reported. Statistical data were collected on 2198 patients who were treated in our emergency department due to upper gastrointestinal bleeding (UGIB) in the form of melena or hematemesis. Upper endoscopy performed within 24 hours of arrival revealed that 796 (36.2%) patients had a peptic ulcer, while the diagnosis of upper gastrointestinal tumor bleeding (UGITB) was verified in 61 (2.8%) patients. During the five-year study, it was shown that men had a higher prevalence of bleeding compared to women (PUB 62.3% vs. UGITB 52.5%). The cumulative incidence of UGIB was 126/100,000. It was found that the largest number of bleeding tumors were located in the stomach (n=58, 95%), with most of them being malignant tumors (n=55, 90%), specifically adenocarcinomas (n=48, 87.3%). The percentage of re-bleeding was lower (9.7% vs. 19.7%, p<0.01) and blood transfusions were less often required (49.5% vs. 75.4%, p<0.01) in PUB. Due to uncontrolled bleeding (5.9% vs. 3.3%, p<0.01), surgical treatment was more often required in cases of PUB, as well as larger volumes of blood transfusion. Patients with PUB had a lower rate of re-bleeding, required surgical intervention more often, and required red blood cell transfusions less frequently.

Total hip arthroplasty (THA) is one of the most successful surgeries. Cemented, uncemented and hybrid methods of implant fixation can be used with different chances for implant survival. There is no consensus on the best fixation method. The aim of the study was to compare the groups of uncemented and hybrid implants according to survival, revision risk and revision cause. Until October 2015, a total of 199 THA uncemented and hybrid (uncemented acetabulum, cemented femur) implants implanted during the 1995-2003 period that had revision or last x-ray taken at least seven years after the initial operation were included in the study. Revision rate, risk factors, revision cause and revised components were investigated. A significant difference was found in the revision rate, i.e., 48 (27.9%) in uncemented group versus 13 (48.1%) in hybrid group (p=0.032). The relative risk for revision was significantly higher (RR=1.72; 95% CI: 1.09-2.73; p=0.019) in hybrids, most often due to loosening (p=0.004). The linear wear of polyethylene was the main cause of revision in uncemented THA (p<0.001). In hybrid group, larger revision replacing the femoral component was most often performed. Uncemented THA showed a lower revision rate, lower revision risk, and required 'minor' revisions compared to the hybrid ones.

Sexuality is a complex process, a natural biological human need that is present throughout life. Closely related to sexuality is the sex drive (libido), which is the basis of human sexual activity. An important aspect of sexuality in both sexes is also the experience of orgasm. Feelings of shame, guilt, fear, and despair contribute to the development of a disorder in the orgasmic experience. The aim of this paper is to present the factors that influence the frequency of orgasmic experiences in women and to determine their sexual satisfaction. We used the online original questionnaire. The target population were adult women. The survey was conducted from June to July 2021. Data were analyzed using SPSS 26.0 statistical software. A total of 1409 questionnaires were completed. Most participants were between 21 and 30 years old and had a high school education, more than half experienced orgasm most often during masturbation, and most experienced it every time during masturbation. More than half experienced clitoral orgasm most often. The factors that bother the respondents most in their sex life were too little foreplay, too little passion, and too short sex. Sexual satisfaction is experienced by people very individually and depends on many factors, such as the quality, frequency, and pleasure attributed to sexual activities, but also on general health and well-being.

Leptin is a protein hormone secreted by adipocytes. Its role in malnutrition-inflammation complex syndrome (MICS) in hemodialysis (HD) patients has not been fully resolved yet. We aimed to assess the predictive role of serum leptin in MICS in maintenance HD patients. This prospective study included 93 HD patients who were distributed in three groups according to serum leptin levels (low-normal-high). Nutritional and inflammatory parameters of MICS, as well as malnutrition-inflammation score (MIS), were determined at baseline and after 12 months. In all subjects, the median serum leptin levels were above the relevant reference range at both the baseline (10 ng/mL; interquartile range (IQR) 4.2-29.9 ng/mL) and at the 12-month follow-up (13 ng/mL; IQR 3.5-39.5 ng/mL). Patients with decreased serum leptin levels had elements of MICS present. Leptin exhibited good sensitivity (0.89), while its specificity was similar to that of other nutritional and inflammatory parameters (0.45 for leptin vs. 0.65 for body mass index, 0.46 for MIS, 0.63 for C-reactive protein, 0.44 for albumins, 0.47 for ferritin and 0.50 for transferrin). The ROC curve analysis identified leptin levels of ≤3.4 ng/mL in men and ≤11.4 ng/mL in women to have the best predictive value for MICS. In conclusion, leptin appears to be a reliable marker of MICS.

The aim of the study was to determine changes in body mass index (BMI) and in the prevalence of overweight and obesity in Serbian adult population. Data for this study were obtained from three National Health Interview Surveys, carried out as cross-sectional, nationally representative surveys in 2000, 2006 and 2013. The values of p for trends of sociodemographic and health related behavioral characteristics, of BMI distribution, and of overweight and obesity prevalence were determined by univariate and multivariate linear and logistic regression analyses, with year of survey as a continuous variable. The mean values of BMI and standard deviations in surveys were 26.09±3.92, 26.28±4.02 and 26.87±4.33 in men, and 25.91±5.25, 25.77±5.22 and 26.35±5.58 in women, respectively (trend p<0.001 both). The prevalence of obesity was 14.3%, 16.5% and 21.4% in men, and 20.0%, 19.7% and 23.3% in women, respectively (trend p<0.001 both). The prevalence of overweight did not change significantly during the observed period. In conclusion, the prevalence of obesity showed an increasing trend in both men and women, demanding targeted public health interventions.

Diagnosis of tuberculous spondylodiscitis is difficult because clinical findings usually are nonspecific and radiological features may mimic other bacterial, fungal, inflammatory and neoplastic diseases. We present the first reported case of tuberculous spondylodiscitis in a 56-year-old man successfully treated by rifampicin-containing anti tuberculosis regimen with close follow-up of serum cyclosporine levels.

The role of an accessory renal artery in the pathogenesis of hypertension is still controversial. In this report, we describe a previously healthy 16-year-old girl with an accessory right renal artery who presented with hypertensive urgency (no progressive target organ dysfunction). Initial workup other than hypercholesterolemia and mild proteinuria was normal with no signs of other target organ damage. Further evaluation was aimed at determining the possible cause of secondary hypertension. High normal plasma renin with elevated plasma aldosterone led to a suspicion of renovascular hypertension. Magnetic resonance angiography and later computed tomography angiography showed two non-stenotic right renal arteries. Another diagnostic workup was normal. A satisfactory blood pressure control was eventually achieved with combination therapy including angiotensin-converting enzyme inhibitor. We conclude that although non-stenotic, an accessory renal artery should be considered as a possible cause of renovascular hypertension in children and adolescents even in the absence of hyperreninemia.

Parathyroid cancer is an extremely rare malignancy that usually leads to hyperparathyroidism. The aim of this report is to present clinical and ultrasonographic features of tumors in six patients (5 females; mean age 53.2 years) treated for parathyroid carcinoma at the Department of Nuclear Medicine during 20 years. Most patients presented with hypercalcemia, and one of them had a previous history of long-term secondary hyperparathyroidism and was treated with hemodialysis. All patients had significantly reduced bone density, and two of them presented with typical 'brown' tumors involving long bones of lower extremities. After initial treatment, all patients except for the youngest female patient were in long-term remission with normal serum calcium and parathyroid hormone levels. Preoperative imaging procedures such as ultrasound with targeted fine needle-aspiration biopsy and Tc99m-sestamibi scan helped determine the location and extent of the disease, but definitive diagnosis was made after the surgery. Parathyroid cancer is a rare form of malignant tumor that is difficult to diagnose preoperatively due to similar clinical features with benign causes of hyperparathyroidism such as hyperplasia and adenomas, especially atypical ones that require regular follow-up. Complete surgical resection provides the best chance of cure, although metastatic disease is possible.