Medical emergencies in dental offices in Slovenia and readiness of dentists to handle them

Introduction. Dentists, and all other dental healthcare workers, can expect to face a medical emergency directly or indirectly related to dental treatment. Tis study evaluates the incidence of medical emergencies in dental ofces in Slovenia, the readiness of dentists and possession of specifc medical equipment. Methods. An anonymous online based questionnaire was sent through the Medical Chamber of Slovenia via email to all 1503 active dentists in Slovenia. Te questionnaire was pilot-tested on 25 dentists and improved accordingly. Tirty closedended questions were answered by 289 (19.2 %) dentists. Results. 93.4 % (n=267) of dentists reported a medical emergency in their dental offce. Te most prevalent diagnosis was syncope (1.88-2.44/dentist/year) followed by hypoglycaemia (0.20-0.25/dentist/year), hypertensive crisis (0.4/dentists/year) and anaphylaxis (0.3/dentists/year). Tere were no cardiac arrests reported in the dentists’ entire careers. 85.1 % (n=239) of dentists underwent postgraduate BLS training, 87.4 % (n=209) of them in the last 5 years. Responding dentists estimated that they are most capable of dealing with syncope and least profcient in dealing with stroke, cardiac arrest and a hypertensive crisis. Tey felt generally more prepared to manage than diagnose a medical emergency. Only 58.1 % (n=161) of dentists have access to a self-infating bag with a reservoir, and 54.9 % (n=152) to an oxygen mask. Only 4.0 % (n=11) of them have a full set of equipment recommended by Medical Chamber of Slovenia. Conclusions. Results support modifcation of the undergraduate and postgraduate curriculum for dental students to address specifc medical emergencies and the usage of limited equipment. Tey support more rigorous regulations concerning postgraduate education and specifc equipment for dealing with medical emergencies in dental offices in Slovenia

Sulfonylureas in type 2 diabetes mellitus: current evidence, conflicts and clinical implications

Introduction: We sought to explore the current state of evidence on sulfonylurea therapy in type 2 diabetes mellitus (T2DM) and critically examine the recommendations of major practice guidelines,and the overall ramifications of the issues thereof in current clinical practice.Method: We searched PUBMED, MEDLINE and other databases, and selected, analysed and interpreted relevant original studies,reports and reviews on the subject.Results: A compelling body of literature exist on the sulfonylurea use in T2DM, with a remarkable number of studies illuminating substantial clinical issues associated with their use. Nevertheless, definitive evidence is still limited in terms of unequivocally clarifying some of the concerns. All major practice guidelines mirrored a historical trend of consistent endorsement of sulfonylureas as first or second line agents in T2DM management. However, based on re-evaluation of available evidence, some latest guidelines have reflected a significantly declined confidence in the traditional status accorded to sulfonylureas in T2DM management, conspicuously contrasting other existing guidelines.Conclusion: The apparent inconsistencies and deficiencies in the available body of evidence and the conflicting recommendations in current guidelines have raised new questions and complicated clinical considerations, creating a novel dilemma in the clinical use of sulfonylureas.Keywords: Sulfonylurea; type 2 diabetes mellitus; evidence;guidelines; clinical practic

Dopamine Autoxidation Is Controlled by Acidic pH

We studied the reaction mechanism of dopamine autoxidation using quantum chemical methods. Unlike other biogenic amines important in the central nervous system, dopamine and noradrenaline are capable of undergoing a non-enzymatic autoxidative reaction giving rise to a superoxide anion that further decomposes to reactive oxygen species. The reaction in question, which takes place in an aqueous solution, is as such not limited to the mitochondrial membrane where scavenging enzymes such as catalase and superoxide dismutase are located. With the experimental rate constant of 0.147 s−1, the dopamine autoxidation reaction is comparably as fast as the monoamine oxidase B catalyzed dopamine decomposition with a rate constant of 1 s−1. By using quantum chemical calculations, we demonstrated that the rate-limiting step is the formation of a hydroxide ion from a water molecule, which attacks the amino group that enters intramolecular Michael addition, giving rise to a pharmacologically inert aminochrome. We have shown that for dopamine stability on a time scale of days, it is essential that the pH value of the synaptic vesicle interior is acidic. The pathophysiologic correlates of the results are discussed in the context of Parkinson's disease as well as the pathology caused by long-term amphetamine and cocaine administration

UPOTREBA KONCENTRATA PROTROMBINSKOG KOMPLEKSA I KONCENTRATA FIBRINOGENA NA OSNOVI REZULTATA TESTA ROTEM® U LIJEČENJU TEŠKE KOAGULOPATIJE ZBOG MANJE ABRUPCIJE POSTELJICE

Placental abruption can cause signifi cant hemorrhage and coagulopathy that can progress rapidly due to consumption and depletion of clotting factors. Rapid detection and treatment of hypofi brinogenemia is essential in the evolving clinical and hematologicmilieu. The use of ROTEM® allows a dynamic monitoring of coagulopathy. So far, only fi brinogen concentrate has been described for prompt management of severe coagulopathy associated with placental abruption. We report a case of a 40-year-old multipara with minor placental abruption complicated by severe coagulopathy, where a combination of prothrombincomplex and fi brinogen concentrate was used for prompt treatment. Potential benefi ts and drawbacks of prothrombin complex concentrate therapy, as well as diagnostic and therapeutic considerations of ROTEM® - guided test are discussed.Abrupcija posteljice može uzrokovati veći gubitak krvi i potrošnu koagulopatiju koja vodi do smanjenja ili nedostatka faktora koagulacije. Brzo otkrivanje nedostatka fi brinogena i ciljano usmjerena hemostatska terapija neophodni su za učinkovitu hemostazu kod abrupcije placente. Korištenje ROTEM® omogućuje dinamičko praćenje koagulopatije. Do sada je u literaturi opisano liječenje teške koagulopatije zbog abrupcije posteljice samo koncentratom fi brinogena. Prikazujemo višerotkinju u dobi od 40 godina kod koje je došlo do abrupcije posteljice s teškom koagulopatijom, gdje je za ciljano liječenje korištena kombinacija protrombinskog kompleksa i koncentrata fi brinogena. U članku raspravljamo o potencijalnim prednostima i nedostatcima terapije koncentratom protrombinskog kompleksa, kao i o dijagnostičkim i terapijskim mogućnostima ROTEM®-a

UPOTREBA KONCENTRATA PROTROMBINSKOG KOMPLEKSA I KONCENTRATA FIBRINOGENA NA OSNOVI REZULTATA TESTA ROTEM® U LIJEČENJU TEŠKE KOAGULOPATIJE ZBOG MANJE ABRUPCIJE POSTELJICE

Placental abruption can cause signifi cant hemorrhage and coagulopathy that can progress rapidly due to consumption and depletion of clotting factors. Rapid detection and treatment of hypofi brinogenemia is essential in the evolving clinical and hematologicmilieu. The use of ROTEM® allows a dynamic monitoring of coagulopathy. So far, only fi brinogen concentrate has been described for prompt management of severe coagulopathy associated with placental abruption. We report a case of a 40-year-old multipara with minor placental abruption complicated by severe coagulopathy, where a combination of prothrombincomplex and fi brinogen concentrate was used for prompt treatment. Potential benefi ts and drawbacks of prothrombin complex concentrate therapy, as well as diagnostic and therapeutic considerations of ROTEM® - guided test are discussed.Abrupcija posteljice može uzrokovati veći gubitak krvi i potrošnu koagulopatiju koja vodi do smanjenja ili nedostatka faktora koagulacije. Brzo otkrivanje nedostatka fi brinogena i ciljano usmjerena hemostatska terapija neophodni su za učinkovitu hemostazu kod abrupcije placente. Korištenje ROTEM® omogućuje dinamičko praćenje koagulopatije. Do sada je u literaturi opisano liječenje teške koagulopatije zbog abrupcije posteljice samo koncentratom fi brinogena. Prikazujemo višerotkinju u dobi od 40 godina kod koje je došlo do abrupcije posteljice s teškom koagulopatijom, gdje je za ciljano liječenje korištena kombinacija protrombinskog kompleksa i koncentrata fi brinogena. U članku raspravljamo o potencijalnim prednostima i nedostatcima terapije koncentratom protrombinskog kompleksa, kao i o dijagnostičkim i terapijskim mogućnostima ROTEM®-a

Učinkovitost aerosolne škatle za preprečevanje okužb pri posegih, pri katerih nastajajo aerosoli

Izpostavljenost okužbi zdravstvenih delavcev zaradi pandemije covida-19 je privedla do razvoja novih oblik osebne varovalne opreme. Ena od njih je aerosolna škatla, ki je bila zasnovana z idejo, kako varneje vstaviti dihalno cevko v sapnik bolnikom, okuženim z virusom SARS-CoV2. Uporaba aerosolne škatle ne sega samo v področje anesteziologije, ampak tudi v druga področja medicine. Številne kritike na račun prvotne zasnove so vodile v izdelavo novih oblik, ki postopoma izboljšujejo prvotne pomanjkljivosti. Razvoj se usmerja predvsem v okoliščino, kako zmanjšati oviranost kirurga (ali izvajalca) pri posegih ter kako zagotoviti varnejšo, enostavnejšo in hitrejšo možnost uporabe. Številnim avtorjem je uspelo pokazati, da uporaba aerosolne škatle pomembno vpliva na hitrost vstavitve dihalne cevke v sapnik, zato v urgentnih primerih odsvetujejo uporabo aerosolne škatle. Ob primerni uporabi ter ustreznem urjenju zdravstvenega delavca pa se je izkazala kot učinkovita osebna varovalna oprema, ker zdravstvene delavce dobro zaščiti pred velikimi in majhnimi vodnimi kapljicami. Pravilno posodobljena oblika aerosolne škatle dobro varuje tudi pred aerosolnimi delci, medtem ko uporaba izvorne oblike lahko tveganje za okužbo zdravstvenega delavca z aerosolnimi delci še poveča

Analgesic efficacy of remifentanil patient-controlled analgesia versus combined spinal-epidural technique in multiparous women during labour

Objectives: To compare the analgesic profile of remifentanil patient-controlled analgesia (RPCA) and combined spinal-epidural analgesia technique (CSEA) in multiparous women during the entire labour. We hypothesized that CSEA would provide a better and more sustained pain reduction than RPCA.Material and methods: A prospective observational trial under ID NCT02963337 at a university hospital in Slovenia 2017–2018. Analgesic efficacy, satisfaction with pain-relief, adverse effects, labour progress, and outcomes between RPCA (80) and CSEA (81) were compared.Results: CSEA provided significantly lower pain scores during the entire labour. Compared to baseline, significant pain reduction was recorded in both groups after 15 min. No difference was recorded compared to baseline with RPCA and CSEA after 45 and 90 mins, respectively. CSEA provided higher satisfaction than RPCA (5 [5–5] vs 5 [4–5], p < 0.0001). More patients with CSEA opted for the same technique for the next labour [CSEA; 77 (95%) vs RPCA; 65 (81%), p = 0.003]. No crossovers were observed. RPCA was associated with desaturation (34%), bradypnea (21%) and apnoea (25%), which were transitional and easily managed. None had severe sedation. No differences were recorded in labour progress and outcomes. Apgar scores were reassuring in all neonates (> 8). None had umbilical artery pH < 7.0.Conclusions: In multiparas, CSEA provided superior analgesia and satisfaction than RPCA. Nevertheless, RPCA provided a satisfactory experience, suggesting it could be used when neuraxial analgesia is not available, preferred, or contraindicated. In that case, constant presence of midwife is mandatory for management of clinically significant hypoventilation

Exploration of macromolecular phenotype of human skeletal muscle in diabetes using infrared spectroscopy

IntroductionThe global burden of diabetes mellitus is escalating, and more efficient investigative strategies are needed for a deeper understanding of underlying pathophysiological mechanisms. The crucial role of skeletal muscle in carbohydrate and lipid metabolism makes it one of the most susceptible tissues to diabetes-related metabolic disorders. In tissue studies, conventional histochemical methods have several technical limitations and have been shown to inadequately characterise the biomolecular phenotype of skeletal muscle to provide a holistic view of the pathologically altered proportions of macromolecular constituents.Materials and methodsIn this pilot study, we examined the composition of five different human skeletal muscles from male donors diagnosed with type 2 diabetes and non-diabetic controls. We analysed the lipid, glycogen, and collagen content in the muscles in a traditional manner with histochemical assays using different staining techniques. This served as a reference for comparison with the unconventional analysis of tissue composition using Fourier-transform infrared spectroscopy as an alternative methodological approach.ResultsA thorough chemometric post-processing of the infrared spectra using a multi-stage spectral decomposition allowed the simultaneous identification of various compositional details from a vibrational spectrum measured in a single experiment. We obtained multifaceted information about the proportions of the different macromolecular constituents of skeletal muscle, which even allowed us to distinguish protein constituents with different structural properties. The most important methodological steps for a comprehensive insight into muscle composition have thus been set and parameters identified that can be used for the comparison between healthy and diabetic muscles.ConclusionWe have established a methodological framework based on vibrational spectroscopy for the detailed macromolecular analysis of human skeletal muscle that can effectively complement or may even serve as an alternative to histochemical assays. As this is a pilot study with relatively small sample sets, we remain cautious at this stage in drawing definitive conclusions about diabetes-related changes in skeletal muscle composition. However, the main focus and contribution of our work has been to provide an alternative, simple and efficient approach for this purpose. We are confident that we have achieved this goal and have brought our methodology to a level from which it can be successfully transferred to a large-scale study that allows the effects of diabetes on skeletal muscle composition and the interrelationships between the macromolecular tissue alterations due to diabetes to be investigated

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake