Acta clinica Croatica最新文献

The aim of the study was to determine major adverse cardiac events (MACE) related to the percutaneous coronary intervention (PCI) on saphenous vein graft (SVG) with a second-generation drug eluting stents in patients with previous coronary artery bypass graft (CABG). The research was conducted as a unicenter retrospective observational study which analyzed consecutive patients of both genders who had PCI on SVG from January 1, 2016 until June 30, 2019. The aim was to investigate the occurrence of MACE defined as development of periprocedural myocardial infarction, acute heart failure in the first 24 hours after PCI, unstable angina after PCI, periprocedural stroke, contrast induced nephropathy, death, acute/subacute/late stent thrombosis, and target lesion revascularization. The study included 97 consecutive patients. MACE was recorded in 20.6% of patients, more often in patients with thrombolysis in myocardial infarction grade flow ≤2. High thrombus burden (HTB) was detected in 44.3% of patients and it significantly contributed to the development of MACE. In conclusion, PCI on SVG is a highly challenging procedure, especially in patients with an acute coronary syndrome. In patients who have HTB recorded in SVG, the usage of thrombus aspiration and distal protection device can reduce the frequency of no-reflow phenomenon and consequential MACE.

The aim of this study was to determine the frequency of hypophosphatemia in female patients with iron deficiency anemia (IDA) treated parenterally with ferric carboxymaltose (FCM). Thirty-two female patients examined for IDA at the Hematology and Oncology Department of one General Hospital were included in the study. The inclusion criteria were hemoglobin <110 g/L, transferrin saturation <50%, ferritin <30 ng/mL, and ineffective oral iron therapy. The hemoglobin values were significantly increased 6 weeks after therapy in comparison with initial values. The onset of the asymptomatic hypophosphatemia was observed in 17 of 32 patients two weeks after the FCM therapy. Only one of 32 patients had severe asymptomatic hypophosphatemia (serum phosphate <0.3 mmol/L). Prolonged hypophosphatemia (6 weeks after FCM therapy) was observed in five of 32 patients, of which only one patient had initial hypophosphatemia. The difference between the phosphate values measured two weeks after the FCM therapy and the phosphate values at the first and last follow-up was statistically significant. Serum phosphate values should be routinely measured before and after parenteral FCM therapy.

The aim of this prospective study was to determine changes in central macular thickness in the early postoperative period after uncomplicated phacoemulsification cataract surgery in diabetic patients using spectral domain optical coherence tomography (SD-OCT). Uncomplicated ultrasound phacoemulsification cataract surgery causes minimal changes of retinal layer thickness, which may result in subclinical cystoid macular edema development. This prospective study included 55 patients divided into two groups. Group 1 included diabetic patients with cataract, and group 2 included patients with cataract and without diabetes. All patients underwent uncomplicated ultrasound phacoemulsification cataract surgery at the Department of Ophthalmology, University Hospital Osijek in the period from November 2017 to January 2018. Patients were followed-up for one month after surgery. At each examination, OCT recording of the eye undergoing cataract surgery was performed. A statistically significant difference in central macular thickness in the diabetic group and control group (p=0.0005 both) was confirmed preoperatively and one month after cataract surgery. A statistically significant difference in central macular thickness was confirmed in diabetic group (p=0.006), as well as in the control group of patients (p=0.01) seven days and one month after cataract surgery. There was no statistically significant difference in macular thickness changes between the diabetic and control group of patients preoperatively (p=0.618), seven days (p=0.6848) or one month after cataract surgery (p=1). The effect of HbA1c on macular thickness change in diabetic patients was not statistically significant. The mean HbA1c in diabetic patients was 7.24±1.34%. There was no statistically significant difference in the effect of cumulative dissipated energy on macular thickness change in either group. This study confirmed a statistically significant correlation of the effect of fluid volume consumption on macular thickness changes in diabetic patients. There was no statistically significant effect of fluid volume consumption on macular thickness change in the control group of patients. Uncomplicated ultrasound phacoemulsification cataract surgery caused changes in cen-tral macular thickness in the early postoperative period in both patient groups. Changes in central macular thickness in the observed period were not manifested with clinically significant macular edema or by a more significant decrease in visual acuity. All patients had significant improvement in visual acuity seven days and one month after cataract surgery.

Vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) inhibitors are two main groups of drugs for targeted treatment of metastatic renal cell carcinoma (mRCC). Inhibition of angiogenesis and other growth pathways that are pivotal for tumor progression lead to significant improvement of survival in patients with mRCC. The main aim of this study was to compare the effects of temsirolimus (mTOR inhibitor) and interferon alpha-2a (IFN-alpha-2a) on overall survival (OS) and progression-free survival (PFS) in patients with T3 stage mRCC who developed lung metastasis in the first two years after radical nephrectomy. A total of 60 patients diagnosed with T3 stage renal cancer who developed metastases in the lungs within two years after radical nephrectomy were included in a prospective study conducted at the Department for Urology, Clinical Center of Vojvodina and partially retrospective study at the Oncology Institute in Sremska Kamenica. Patients were divided into two groups consisting of 30 patients according to treatment with temsirolimus or IFN-alpha. During the first year of treatment, OS of patients treated with temsirolimus was 23.33%, whereas in patients treated with IFN-alpha it was 16.67%. Median survival in patients treated with temsirolimus was 9.3 months, whereas in patients treated with IFN-alpha it was 6.9 months, yielding a statistically significant difference (p=0.028). Patients treated with temsirolimus showed a statistically significantly longer median PFS compared to patients treated with IFN-alpha (p<0.0085). In conclusion, temsirolimus therapy had a significantly positive effect on survival in patients with mRCC. Patients treated with temsirolimus showed significantly longer median survival and median PFS compared to patients treated with IFN-alpha.

In the area of today's Krapina-Zagorje County, after World War II, there were three outpatient maternity departments (OMD) in Krapina, Klanjec and Pregrada, making a considerable step forward in public health improvement. The first and biggest OMD was located in the Klanjec Public Health Center. In parallel with establishment of the maternity hospital (MH) in Zabok, all OMDs throughout today's Krapina-Zagorje County were closed. The aim of our research was to present the activities of Klanjec OMD (KOMD) and show its impact on perinatal health. Data on KOMD activities were obtained from the Birth Registry. Major obstetric procedures, including delivery by cesarean section, were not performed in KOMD. Based on the above, numerous transports of women in labor and postpartum transports were organized to maternity wards in large centers. The most common cause for transport were transports during childbirth caused by prolonged labor. In conclusion, organization of OMD in the area of today's Krapina-Zagorje County significantly improved perinatal care in the 1950s. It was followed by gradual closure of OMD which could not meet the newly set spatial, material and personnel demands, along with the establishment of maternity hospitals in general and university hospitals. The trend of perinatal and maternal mortality reduction in the Zagorje region that began with the establishment of inpatient maternity department at the Zabok Hospital continues to this day.

The aim of the present study was to assess mild cognitive impairment (MCI) and cardiometabolic risk factors (CMRF) in Bosnian and Herzegovinian patients with heart failure (HF). This study included 80 patients with HF and 40 healthy controls. Montreal Cognitive Assessment (MoCA) testing was used to evaluate cognitive function. Abdominal obesity was assessed by waist circumference, and hypertension was assessed by the auscultatory method. Data on other CMRF and comorbidities, such as diabetes, smoking, alcohol consumption, and atrial fibrillation (AF), were gathered with a specially designed questionnaire. Lipids, C-reactive protein (CRP), and fibrinogen were assessed with standard laboratory methods. Student, Mann-Whitney, and Chi-square tests were used to determine significant differences between groups. Associations between categorical variables and correlation coefficients were assessed by the Chi-square and Spearman test, respectively. The prevalence of MCI in patients with HF was 77.5%. We found significant associations between MCI and diabetes, hypertension, AF, and smoking in patients with HF. We found no significant associations between MCI, abdominal obesity, and alcohol consumption. A significant positive correlation between MCI and total cholesterol was observed in patients with HF. Furthermore, a lower MoCA score was associated with higher values of CRP and fibrinogen in HF patients. The present study showed a high prevalence of MCI in Bosnian and Herzegovinian HF patients as well as its association with various CMRFs. These results suggest it is necessary to begin MCI screening in HF patients, especially since data from the literature point to improvement in cognitive performance with appropriate HF and concomitant CMRF treatment.

Recent studies have shown an association of the number of tumor-associated macrophages (TAM) with the prognosis and treatment outcomes of ductal pancreatic adenocarcinoma. This study aimed to examine the correlation between CD86 and CD163 macrophage expression and clinical-pathological characteristics of the disease in patients operated on for pancreatic carcinoma. A retrospective research was conducted in which the archival materials of the Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital Center were used together with all relevant patient clinical data obtained from the Hospital Information System on 76 patients operated on for pancreatic adenocarcinoma. In our study, the number of CD86 macrophages and the CD86/CD163 ratio showed a statistically significant correlation with increasing T and N stages of the disease. The number of CD163 macrophages did not show a statistically significant correlation with the mentioned variables. These results indicated that in our clinical conditions, proinflammatory (M1) macrophages were more expressed in locally advanced tumor stages with worse long-term prognoses. In conclusion, TAMs could be a valid prognostic marker or even a target for therapeutic agents but more studies will be needed to fully comprehend the impact of M1/M2 differentiation.

The COVID-19 pandemic has hit the entire world. While symptomatic patients can be taken out of the infection chain, asymptomatic cases are very important for the spread of SARS-CoV-2. We investigated the relationship between isolating asymptomatic COVID-19 cases with close contacts by identifying and breaking the infection chain. This study included 3 asymptomatic COVID-19 cases identified during screening and 25 close contacts as a result of filiation. Twenty-five people with close contact were classified into groups A (n=8), B (n=6) and C (n=11). On SARS-CoV-2 PCR tests performed in close contacts, all of them were negative on day 0, whereas two group C subjects were positive on day 7. On antibody test applied on day 28, six subjects were positive in group A, two subjects were positive in group B, and one subject was positive in group C. A statistically significant decrease was observed in the number of infected people in the group where asymptomatic cases were identified and removed (p=0.04). It was determined that asymptomatic COVID-19 cases who were not isolated from the community had a 5-fold increased risk of infection. Screening and identification of asymptomatic cases is also essential to augment the effectiveness of quarantine and isolation measures.

Dengue virus is endemic in almost all tropical and sub-tropical countries which also are popular tourist destinations, and it is a major international public health problem. Presented herein are six travel-associated dengue fever cases diagnosed between 2016 and 2017 in Turkey. The current situation in Turkey and in the world, as well as epidemiological data regarding the vector and relationship between the disease and traveling are also discussed. This retrospective study evaluated dengue fever cases identified using serological and molecular methods between January 2016 and February 2017 in the National Virology Reference Laboratory. Two patients had a travel history to Maldives, two patients to Thailand, one patient to Sri Lanka, and one patient to Guiana. Fever was present in all cases. The most common other symptoms were fatigue, myalgia, and arthralgia. Increased liver enzymes (50%) and thrombocytopenia (66%) were the most commonly encountered laboratory changes. In conclusion, imported dengue fever cases are increasingly reported due to facilitation of international travels and increasing commercial activities. Before traveling to a region where dengue fever is endemic, consulting a travel medicine counseling desk or a doctor is suggested. Dengue fever should be kept in mind in a patient with travel history presenting with fever, elevated liver enzyme and thrombocytopenia.

Acute lower respiratory tract infection (LRTI) is common in children and associated with high morbidity and mortality. The aim of this study was to determine the distribution of respiratory viruses leading to admission of a child with the diagnosis of LRTI to pediatric intensive care unit (PICU). The distribution of viral pathogens was determined using viral multiplex polymerase chain reaction (PCR) in children with LRTI admitted to PICU at a tertiary-level reference pediatric hospital. The LRTI patients without a positive viral multiplex PCR finding were excluded from the study. Most patients were under 2 years of age (78.3%), and the most common viral pathogen resulting in PICU admission due to viral LRTI was RSV A/B (32.8%). Thirty three patients had an underlying disease. Ten (16.6%) patients required invasive mechanical ventilation (IMV), 37 (61.6%) required high-flow oxygen therapy (HFOT), and two patients (3.3%) progressed to pediatric acute respiratory distress syndrome (PARDS). Underlying chronic disease presence was the highest in the IMV group with 90%, which decreased to 54% and 30.7% in the HFOT and standard oxygen treatment groups, respectively (p=0.018). The patients with IMV requirements had significantly longer hospital stay (median 8 days, range 6-13 days) compared to HFOT group (median 6 days, range 4-7.5 days] and regular oxygen treatment group (median 3 days, range 2-3.5 days) (p<0.001). The use of multiplex PCR for respiratory viruses may help in discriminating etiologic viral agents in patients admitted to PICU and estimating possible complications associated with viral-specific disease. The presence of an underlying disease in a patient with viral LRTI affects the treatment level, and treatment level affects the duration of PICU stay.