Acta Informatica Medica最新文献

Background: Cardiosurgical patients can be often anemic, and preoperative anaemia is associated with increased postoperative complications, as well as morbidity and mortality.

Objective: The present study was conducted aiming to determine the influence of lower preoperative hematocrit values on the early postoperative recovery of patients undergoing elective off-pump coronary artery bypass grafting (OPCABG).

Methods: Our retrospective study included 150 patients who underwent elective OPCABG surgery from September 2021 to December 2022 at the Clinic for Cardiovascular Surgery University of Sarajevo. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin level <130g/l males and <120g/l females. Study observed comorbidities and early postoperative data.

Results: Overall prevalence of anemia in OPCABG patients was 36,6%, more frequent among older patients. Comorbidities as chronic obstructive pulmonary disease, hypertension, ejection fraction was quite similar in both groups, but body mass index was significantly higher in the group of patients with anemia (29.9% vs 28.4%). In early recovery period, vasopressors were more used in patients with anemia (63.6% vs 42.1%) and their doses were higher. Total drainage was higher in patients with anemia (744.45±45.72 ml vs 681.58±349.06 ml). Number of transfusions was higher in the group of patients with anemia: red blood cells (0.89±1.29 vs 0.29±0.84; p<0,05), fresh frozen plasma (0.65±1.13 vs 0.41±1.15; p<0,05) and platelets (0.11±0.57 vs 0,07±0.42; p>0,05). Duration of mechanical ventilation was longer in patients with anemia compared to non-anemic patients (623-91±259.83 minutes vs 469±191.13 minutes). Atrial fibrillation occurred more often in patients with anemia (12.7 vs 7.4%). Length of stay in the intensive care unit was without significant difference.

Conclusion: Based on our findings, patients who underwent elective OPCABG with lower than normal hematocrit, needed more blood and blood products, more vasopressor drugs in higher doses, longer mechanical ventilation, all which can prolong the patient's recovery and increase the cost of treatment.

Background: An endodontic treatment consists in cleaning, shaping and filling the root canal system. Irrigation is the chemical part of the process that ensures the total removal of debris. Activating the irrigation solution will improve and accelerate the process.

Objective: The aim of the study is to evaluate the removal of debris and smear layer at 1, 3, and 5mm from the foramen after needle irrigation, EndoActivator® and Irrisafe®. Sixty single-rooted teeth were prepared using Primary WaveOne Gold®.

Methods: Teeth were randomly assigned to 4 groups (n=15): needle irrigation - Group A, EndoActivator® for 1 min - Group B, Irrisafe® for 1 min - Group C, Irrisafe® for 30 sec - Group D. Root canals were observed under a scanning electron microscope. Data were analyzed by Friedman and Wilcoxon tests.

Results: Debris was significantly higher with group A compared to B, C, and D. Irrisafe® was significantly more effective in removing the smear layer than the other groups. However, activation techniques showed less debris and smear layer than needle alone nevertheless.

Conclusion: Irrisafe® showed the best results regardless of time.

Background: Transfusion treatment during life, as well as pregnancy in women, can stimulate the sensitization of the person who received blood, which after the transfusion of blood products can result in the occurrence of moderate to very severe posttransfusion reactions.

Objective: The aim of this study was to examine the specificity and frequency of antierythrocyte antibodies during the pretransfusion treatment of patients depending on the gender, to determine the origin of antibodies in patients serum, as well as to examine their clinical significance.

Methods: Retrospective analysis of documentation was performed in the Department for Pretransfusion Testing, therapy and distribution of blood products, Polyclinic for Transfusion, UKC Tuzla. Data was analyzed by reviewing the written and electronic documentation from the period of 5 years (2018-2022).

Results: A retrospective analysis of 378 procedures for the identification of antierythrocyte antibodies was performed. It was evident that 140 of all detected antibodies belonged to the Rh-system (66.7%), of which 32.4% were anti RhD-antibodies, 20% anti Rh-E, anti Rh-c 7.1%, and in a low percent of anti-C, anti-e and anti-Cw antibodies. Combinations of anti-D and anti-C antibodies showed the highest frequency (34.2%), followed by a combination of anti-E and anti-c antibodies (21%).

Conclusion: Pretransfusion testing represents a very important link in the safety of the use of blood. The identification of antierythrocyte antibodies and the use of phenotyped blood products significantly reduces the risk of posttransfusion reactions and facilitates the implementation of the safe blood policy.

Background: The book "An Impossible Decision - the Life Interrupted by Uncertainty"has been published by Avicena Publisher in Sarajevo, Bosnia and Herzegovina in 2023 - ISBN: 978-9958-720-76-5.

Objective: The aim of this article is to analize what is the most rational and ethical way to treat people facing life-and-death decisions and how do we exactly communicate these inevitable uncertainties that all of us will sooner or later face?

Methods: Author of the book shows real-life relevance to patients often left alone to make these difficult decisions. Using the techniques of medical dramaturgy, this text brilliantly bridges science.

Results and discussion: The author of the book explained and proposed how to educate the public on how medical advances are made and how inferences and evidence are generated and appraised - in the best tradition of evidence-based medicine while highlighting uncertainties and inevitable trade-offs that accompany science, policies, and personal choices in the attempt to arrive at most satisfactory decisions. In addition to the general public, this play's important audiences are students and faculty in humanities disciplines and medical schools. These students are required to read many dense scientific, philosophical, and technical writings (many of which are referenced/annotated in the footnotes in the play). The play provides an exceptional teaching tool, which includes over 35 theoretical concepts to show how they can be applied to decisions relevant to all of us and what shared decision- making entails.

Conclusion: Author's answer on the question "How to make the life and death medical decisions?" coul'd and shoul'd be: The method of using a playwright and Socrates dialogue format to connect the science of uncertainty with personal humanity decision will be appropriate. It will be important and quiet usefull for phisicians and, also, patients in healthcare practice, as joined decision makers.

Background: Sarcoidosis is a multisystem granulomatous disease of unknown etiology, characterized by presence of granulomas in affected tissues with variety in clinical presentations and presents a differential diagnostic and therapeutic dilemma. Clinical presentation of neurosarcoidosis is very variable. Diagnosis is based on clinical and radiological criteria and histological findings of disseminated non-necrotic granuloma followed by negative cultures for bacteria and fungi. MRI plays a key role in detection of lesions located in the brain parenchyma.

Objective: The aim of this article was to present case of a 36-year-old male patient, who came to doctor with symptoms of fever, dry cough with whitish sputum, lymphadenopathy of neck region and neurological disturbances in form of headaches and vision problems.

Case presentation: Patient underwent on pulmonary examination and results indicated presence of sarcoidosis. CT examination was performed (SIEMENS Somatom Definition AS, Erlangen, Germany), which confirmed presence of mediastinal and hilar lymphadenopathy. Ultrasound (US) examination of a neck region was also performed showed significantly enlarged and morphology altered lymph nodes. After biopsy of several neck lymph nodes, histopathological was proven diagnosis of sarcoidosis. Due to neurological disturbances in form of headaches and vision problems patient was examined by an ophthalmologist, neurologist and endocrinologist. Hormonal analysis showed an increase of prolactin and that raised suspicion for neurosarcoidosis. In further diagnostic evaluation it was indicated MRI examination of the brain with focus on sellar region.

Conclusion: Contrast-enhanced MRI is the modality of choice for investigating suspected neurosarcoidosis. The versatility of MR recording and the amount of diagnostic informations obtained from MRI examination is huge. Comparison of MRI sequences obtained, facilitate interpretation of these findings. Obtained MRI information and available literature, correlating with other diagnostic modalities (ultrasound and CT) facilitate understanding of the specific pathology.

Background: Heart attack, or cardiac arrest, became a leading cause of death after the turn of the century. Defibrillation is one of the most important medical advances of the twentieth century. Defibrillation is a critical step in the treatment of cardiac arrest as it can be the only way to restore a normal heart rhythm and save the life of the individual. However, it is important to note that defibrillation is only effective if it is performed quickly and in conjunction with other life-saving measures such as cardiopulmonary resuscitation (CPR). The history of cardiac defibrillation therapy is long and fascinating, spanning several centuries, many countries and continents.

Objective: The aim of this article was to provide historical information about technical and scientific advances in cardiac devices and the development of today defibrillators.

Methods: Review of the available literature, historical data, personal contacts, others and personal experience in this field.

Discussion: In 1947, Beck published the first paper describing open chest defibrillation of the human heart. Ten years later, Kouwenhoven demonstrated that the heart could be defibrillated through a closed chest. The first external defibrillator weighed 120 kg and delivered 500 v of alternating current (AC) potential. The mere size of the defibrillator restricted its use to surgical suites or other areas hospital locations. In many cases, cardiac arrhythmias recurred. This was thought to be related to the amount of energy used to defibrillate the heart which it was believed caused myocardial damage. These factors limited the practical application of defibrillators. By 1956, a unit was built that could be wheeled into the emergency room, plugged into a wall outlet, and deliver 1000 volts. By 1962, Lown realized that AC current resulted in a high frequency of cardiac arrhythmias and cardiac damage. A direct current (DC) defibrillator, consisting of a battery, a capacitor to store energy, and a transformer was developed. The therapy spread from operating rooms to coronary care units and emergency departments and in the late 1960s left the hospital and started appearing on mobile intensive care units. The first portable EMS defibrillators (used by paramedics) emerged in the early 1970s. In 1980 the automatic implantable cardioverter-defibrillator was invented. Automated external defibrillators began appearing in the late 1980s allowing the therapy to be delivered by EMTs and lay people. The 'father' of the modern automated external defibrillator (AED), Professor James Francis (1916-2004) was a physician and cardiologist from Northern Ireland who transformed emergency medicine and paramedic services with the invention of the portable defibrillator.

Conclusion: Defibrillators are critical resuscitation devices. The use of reliable defibrillators has led to more effective tr

Background: Suicide is a global health concern. There are reproductive health-related factors that are responsible for increasing the risk of female suicide. There are a number of studies examining the association between suicide and the menstrual cycle, but still, there are no conclusive findings.

Aim: We aimed to pool data from all the studies reporting data on suicides and the menstrual cycle phase to report the following outcomes: incidence of suicidal deaths in the menstrual, secretory, and proliferative phases, and to find out whether the burden of suicide in the menstrual phase in particular, was more at a young age (18-35 years) or middle age (36-50years).

Methods: The PubMed database was extensively searched from inception till 12^th April 2022. The data for the number of events occurring for each outcome were pooled using random-effects model and forest plots were created.

Results: Five articles were shortlisted for inclusion in our analysis. Incidence of suicide in the secretory phase was highest at 45.2% [95% CI, 0.367-0.537]. The incidence of suicide, when occurring in the menstrual phase, was reported to be 68.4% (95 CI, 0.317-1.052) and 31.6% (95 CI, -0.052.3-0.68) for young-aged and middle-aged victims, respectively.

Conclusion: Our results demonstrate that the menstrual phase has a lower risk of mortality due to suicide when compared to the other two phases of the menstrual cycle. Nevertheless, when suicide occurred in the menstrual phase, the incidence of suicide among the younger age-group was higher than for those in the middle age-group.

Background: Coronavirus disease 2019 (COVID-19) can cause a wide clinical spectrum, ranging from asymptomatic to severe disease with a high mortality rate. In view of the current pandemic and the increasing influx of patients into healthcare facilities, there is a need to identify simple and reliable tools for stratifying patients.

Objective: Study aimed to analyze whether hemogram-derived ratios (HDRs) can be used to identify patients with a risk of developing a severe clinical form and admission to hospital.

Methods: This cross-sectional and observational study included 500 patients with a confirmed diagnosis of COVID-19. Data on clinical features and laboratory parameters were collected from medical records and 13 HDRs were calculated and analyzed. Descriptive and inferential statistics were included in the analysis.

Results: Of the 500 patients, 43.8% had a severe form of the disease. Lymphocytopenia, monocytopenia, higher C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were found in severe patients (p < 0.05). Significantly higher neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), neutrophil-to-platelet ratio (NPR), neutrophil-to-lymphocyte-to-platelet ratio (NLPR) and CRP-to-lymphocyte ratio (CRP/Ly) values were found in severe patients (p < 0.001). In addition, they have statistically significant prognostic potential (p < 0.001). The area under the curve (AUC) for CRP/Ly, dNLR, NLPR, NLR, and NPR were 0.693, 0.619, 0.619, 0.616, and 0.603, respectively. The sensitivity and specificity were 65.7% and 65.6% for CRP/Ly, 51.6% and 70.8 for dNLR, 61.6% and 57.3% for NLPR, 40.6% and 80.4% for NLR, and 48.8% and 69.1% for NPR.

Conclusion: The results of the study suggest that NLR, dNLR, CRP/Ly, NPR, and NLPR can be considered as potentially useful markers for stratifying patients with a severe form of the disease. HDRs derived from routine blood tests results should be included in common laboratory practice since they are readily available, easy to calculate, and inexpensive.