Acta clinica Croatica最新文献

The aim of the study was to determine the effects of smoking on cervical mucus in women with primary idiopathic sterility. A prospective, case-control, observational, quantitative, and analytical study was carried out over a five-year period through ambulatory care. The first part of the study involved 140 healthy women (85 smokers and 55 non-smokers). The second part included 90 women (58 healthy, 32 suffering from sterility), grouped according to their smoking status. Concentrations of total proteins in cervical mucus solutions and homogenates of cervical surface cells and their mitochondria, thiocyanate and ascorbic acid, rhodanese activity, concentrations of cytochrome P-450 (mitochondria), lipid peroxidation and the total antioxidant capacity in homogenates of cervical surface cells, concentrations of superoxide O2, reduced gluthatione (GSH), advanced oxidation protein products (AOPP), and ferric reducing ability of plasma (FRAP) were measured. The measurements showed higher concentrations of thiocyanate, cytochrome P-450 and lipid peroxidation values, and lower concentrations of ascorbic acid, cytochrome P-450 activity and FRAP in smokers. Higher concentrations of superoxide O2, GSH, AOPP, and lower FRAP were found among smokers and women suffering from sterility. In conclusion, changes in oxidative stress and antioxidant capacity caused by smoking indicate that the quality of cervical mucus among patients suffering from sterility is lower compared to healthy women.

Healthcare-associated infections (HAI) cause more deaths in the European Union than all other infectious diseases. Hand hygiene (HH) has been considered the most important means of preventing HAIs but HH compliance is generally less than 50%. One of the five steps that the World Health Organization (WHO) guidelines identify to be specifically implemented are poster reminders. The aim of this study was to evaluate compliance with HH by healthcare workers before and after an intervention on standardized WHO HH poster reminders. An observational one-month study was conducted in a university hospital center surgical intensive care unit. HH compliance was measured through direct observation using WHO observation tool. Intervention was done on day 15 by replacement of standard WHO posters with posters containing a message aimed to call for personal responsibility in patient outcome. A total of 1113 HH opportunities were observed. Overall, HH was performed in 15.4% of cases pre-intervention and 28.3% of cases post-intervention (p<0.001). The preferred method of HH was soap and water. Healthcare workers mostly chose to perform HH after exposure to body fluids, where compliance was 35.1% pre-intervention and 58.7% post-intervention. Gloves were used in 98% of cases of clean/aseptic procedures where HH was not performed. In conclusion, using standard posters to convey additional messages of awareness of consequences and personal responsibility may improve HH and should be considered in multimodal approaches to improve HH compliance.

Large sporting events during the pandemic are organized as 'COVID-19 free zones', function under quarantine measures, and are regularly testing all participants. Recently, point-of-care tests (POCT) for rapid detection of COVID-19 antigen were presented as a cheaper, faster, and easier-to-perform option than reverse transcription polymerase chain reaction (RT-PCR) testing. However, no study confirmed the efficacy of POCT used at a large sporting event that includes close physical contact, such as judo. An observational study was conducted that included 670 participants from 36 countries attending two consecutive judo competitions. In total, 839 RT-PCR tests and 839 POCT tests for COVID-19 were performed. There were 508 participants tested at one time point when entering the venue, while 162 were tested at two time points in order to participate in both competitions. Seven subjects had positive RT-PCR results, while 4 had positive POCT results, meaning the prevalence of COVID-19 at the competitions was 1.04% according to the RT-PCR results. The main finding of this study was that POCT testing proved to be an effective method in detecting true-negative results. However, due to sensitivity that is insufficient to detect all true-positive cases, POCT should always be used in combination with RT-PCR at large sporting events with close physical contact between competitors in order to avoid COVID-19 outbreak.

Individuals with subclinical hypothyroidism have an increased risk of developing clinical hypothyroidism. The thyroid gland, which has the highest concentration of selenium per gram of tissue among adults, plays a crucial role in the metabolism of thyroid hormones. This study aimed to investigate the prevalence of subclinical hypothyroidism in the North Khorasan province of Iran and assess the serum selenium levels in affected individuals. We conducted a prospective study involving 550 females aged 20-55. Serum samples were collected from individuals based on the study's inclusion and exclusion criteria. We measured the serum levels of thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3). Subsequently, individuals with high TSH but normal T4 and T3 levels were selected for further analysis (group I). The serum levels of TSH, T4, T3 (using the ELISA method), and selenium (using the atomic absorption method) were measured and compared with those of a control group comprising healthy women matched to group I in terms of number, age, and body mass index. The overall prevalence of subclinical hypothyroidism in the study population was 6.48%. Significant differences were observed in serum TSH and selenium levels between the subclinical hypothyroidism group and the control group. Furthermore, a positive correlation between TSH and selenium levels was found exclusively within the subclinical hypothyroidism group. The occurrence of subclinical hypothyroidism was positively correlated with serum selenium levels.

The aim was to examine peripapillary and macular superficial vessel density, peripapillary thickness of the nerve fiber layer, and inner thickness of the macula in eyes with primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PXG) depending on the visual field impairment. A total of 50 eyes were diagnosed as POAG and 50 as PXG. Both groups were divided into 3 subgroups according to HAP2 criteria of visual field impairment. All eyes underwent optical coherence tomography angiography (OCT-A). Radial peripapillary capillary (RPC) density, peripapillary retinal nerve fiber layer (pRNFL) thickness, superficial macular vessel density (SMVD), and macular thickness between the inner limiting membrane and inner plexiform layer (ILM-IPL) were compared. The overall mean measured values did not show a statistically significant difference between the groups. All measured parameters were statistically significantly lower with more extensive visual field damage within the group. The strongest positive correlation was found between the pRNFL thickness and RPC density values (p=0.893), and strongest negative correlation between the mean defect of visual field and ILM-IPL (p=-0.824). No statistically significant difference was found between POAG and PXG in all values measured on OCT-A. In conclusion, visual field loss is more strongly correlated with the loss of nerve fiber layer thickness than the superficial vessel density, which may suggest that the loss of RNFL precedes the loss of superficial vessel density.

Environmental factors play an important role in the onset and development of chronic obstructive pulmonary disease (COPD). Previous studies have shown that global DNA methylation could be a useful biomarker in COPD. We hypothesized that COPD patients from two different Croatian regions might have clinical characteristics, quality of life, and global DNA methylation, which could be used as a possible epigenetic marker. The study included 136 COPD patients with an average age of 70 years, of whom about 70% were men. Among them, 37% were active smokers, 58% ex-smokers, and 5% non-smokers. There were 69 patients in Osijek and 67 in Zadar. The control group consisted of 64 subjects who were not diagnosed with COPD or other respiratory diseases, 32 from each center. We analyzed risk factors, severity and type of symptoms, exacerbations, comorbidities, and numerous parameters of lung function, phenotypic characteristics, quality of life, and global DNA methylation. We found that COPD patients in Zadar had more pronounced emphysema (P<0.001), while COPD patients from Osijek had more severe symptoms of cough and expectoration (P<0.001 for both). Patients from Osijek had more cardiovascular comorbidities (P<0.001) and depression (P=0.01) than patients from Zadar. Analysis of global DNA methylation found that patients with COPD had lower values than the control group, but the difference was not statistically significant.

Thyroid-associated ophthalmopathy (TAO) is an autoimmune disorder of the orbit that occurs predominantly in Grave's hyperthyroidism, while it is an uncommon clinical finding in patients with Hashimoto's thyroiditis (HT) and hypothyroidism. We report the case of a 62-year-old female patient who presented with left eyelid edema, proptosis, diplopia, and lateral paralysis of the left eye. Magnetic resonance imaging of the orbits showed retrobulbar mass in the left orbit with hyperintense signals within left medial rectus muscle, offsetting but not infiltrating the optic nerve. An ¹⁸F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) scan revealed pathological ¹⁸F-FDG uptake of expansive mass within rectus medialis muscle of the left eye (SUVmax=11.0) and similar findings in the right eye (SUVmax=7.1). It also displayed increased glucose metabolism in the thyroid gland (SUVmax=6.4). Laboratory findings showed increased thyrotropin level, while thyroid-stimulating-hormone-receptor antibodies were negative. The patient was diagnosed with HT and TAO, so levothyroxine therapy was introduced. Gradual improvement of TAO symptoms was attained a year later. Diplopia subsided and the patient regained complete eye movements. In conclusion, correction of hypothyroidism can significantly improve symptoms of TAO. Additional value of this case report lies in ¹⁸F-FDG PET/CT images displaying increased metabolic activity, which can advance clinical evaluation; however, further research is needed.

This study aimed to determine demographic characteristics, COVID-19 positivity rates of the quarantined individuals, and risk factors between those developing and not developing disease symptoms. The individuals who returned from Mecca, Saudi Arabia to Turkey on March 15, 2020 were transported from the airport to the campus of dormitories and quarantined for 14 days. This study included 2941 passengers who returned from Umrah visit to Turkey and were quarantined between March 15, 2020 and April 2, 2020. There were 1828 (62.2%) women. The polymerase chain reaction (PCR) test was positive in 295 (10%) of those in quarantine, 196 (66.4%) of them women. Among the patients with a positive PCR test result, there was no significant difference between women and men in terms of age and comorbidity. Of the 295 COVID-19 patients detected, 37 (12.5%) had symptoms. There was no significant difference between symptomatic individuals and asymptomatic individuals in terms of age, gender, and comorbidity. Quarantining everyone who has come from risky areas ensures that patients are isolated from the community, which can prevent the spread of the disease.

Pheochromocytomas are rare tumors that present with a broad spectrum of symptoms and signs, making differential diagnosis broad. They can cause a pheochromocytoma crisis that manifests with arterial blood pressure oscillations, and subsequent symptoms and signs of catecholamine overproduction. There are many potential triggers of this condition. This report presents a 33-year-old man with an obvious pheochromocytoma crisis that occurred due to beta-blocker application without a concomitant alpha-blocker. The crisis was treated with high doses of urapidil, and once permanent hemodynamic stabilization was achieved, urapidil was replaced with phenoxybenzamine. This report demonstrates that pheochromocytoma crisis can be successfully treated with urapidil but further consideration is needed on the use of urapidil both in pheochromocytoma crisis and preoperative management of pheochromocytoma patients.

High-speed digital imaging (HSDI) is a contemporary method of the phonation process assessment. It records laryngeal images at a rate of up to 8000 frames per second. Digital kymography (DK) extracts high-speed images sampled at a single point along the vocal folds and enables objective quantification of the vocal fold movements. According to the literature, usage of topical anesthetic (TA) in oral cavity, oropharynx and laryngopharynx prior to examination, in order to reduce pain and discomfort level, is optional but the effect of using TA on the phonation process is not well investigated. The aim of this study was to investigate the effect of using TA during HSDI on DK parameters. We performed a prospective double-blind randomized controlled study on 58 healthy subjects. All subjects were examined on 2 consecutive days using TA and using saline solution (placebo) by the same experienced examiner. DK images, made on the middle of the vocal folds, were obtained from HSDI. Vocal folds were examined across glottal cycles and glottal width and period irregularities, left-right phase asymmetry, and the open, closed, opening and closing quotient were calculated. Our data showed that using TA during HSDI did not induce statistically significant changes of DK parameters in healthy subjects.