17 research outputs found
Razlike u Äimbenicima rizika i ishodu izmeÄu ishemijskog i hemoragijskog moždanog udara
The aim of the study was to justify the hypothesis that risk factors do not differ between ischemic and hemorrhagic stroke. This retrospective study included 1066 stroke patients. The prevalence of risk factors and hospital-based survival were compared between patients with ischemic and hemorrhagic stroke. Data were retrieved from patient records. Statistical analysis was done by use of Ļ-test and t-test for dependent samples. The group of hemorrhagic stroke consisted of 70 (47.9%) female and 76 (52.1%) male patients. The group of ischemic stroke included 450 (48.9%) female and 470 (51.1%) male patients. Ischemic stroke patients had a higher prevalence of hypertension (79% vs. 72%), atherosclerotic diseases (50% vs. 34%) and atrial fibrillation (15.5% vs. 4.2%), and were statistically significantly older (72.5Ā±10.4 VS. 65.7Ā±12.8) than those with hemorrhagic stroke, however, fatal outcome was more common in the latter (26% vs. 17%). In conclusion, data analysis pointed to differences between hemorrhagic and ischemic stroke according to both risk factors and stroke outcome.Cilj studije bio je provjeriti opravdanost hipoteze kako se Äimbenici rizika ne razlikuju izmeÄu ishemijskog i hemoragijskog moždanog udara. Ova retrospektivna studija ukljuÄila je 1066 bolesnika s moždanim udarom. UÄestalost riziÄnih Äimbenika i bolniÄko preživljenje usporeÄeni su izmeÄu bolesnika s ishemijskim i hemoragijskim moždanim udarom. Podatci su izvedeni iz bolesniÄkih kartona. StatistiÄka analiza je provedena pomoÄu Ļ2-testa i t-testa za zavisne uzorke. Skupina bolesnika s hemoragijskim moždanim udarom imala je 70 (47,9%) žena i 76 (52,1%) muÅ”karaca, a skupina s ishemijskim moždanim udarom 450 (48,9%) žena i 470 (51,1%) muÅ”karaca. Bolesnici s ishemijskim moždanim udarom imali su veÄu uÄestalost hipertenzije (79% prema 72%), aterosklerotske bolesti (50% prema 34%) i atrijske fibrilacije (15,5% prema 4,2%) i bili su statistiÄki znaÄajno stariji (72,5Ā±10,4 prema 65,7Ā±12,8) od bolesnika s hemoragijskim moždanim udarom, ali je smrtni ishod bio ÄeÅ”Äi kod ovih potonjih (26% prema 17%). Dakle, analiza prikupljenih podataka ukazala je na razlike izmeÄu hemoragijskog i ishemijskog moždanog udara u riziÄnim Äimbenicima i ishodu bolesti
CT Perfusion and Noncontrast CT in Acute Ischemic Stroke Diagnosing ā Is there Influence on early Thrombolytic Therapy Outcome?
The objective of this study was to compare noncontrast computed tomography (NCCT) and computed tomography perfusion (CTP) in early diagnosis of acute ischemic stroke and to define influence of these diagnostic procedures on early outcome of thrombolytic therapy (TLTH). The study included 45 patients, 35 patients submitted to NCCT and CTP and 10 patients who underwent only NCCT, before CTP was introduced. Based on the National Institute of Health Stroke Scale (NIHSS) score we compared early outcome of patients who received TLTH after NCCT only (group 1) with the early outcome of patients who received TLTH following NCCT and CTP (group 2). Statistically significant difference was found in acute stroke diagnosing between CTP and NCCT (p=0.002). There were no statistically significant differences in TLTH early outcome between group 1 and group 2. In conclusion, CTP should be done regulary in patients presenting with acute ischemic stroke symptoms. More research needs to be done in defining exact influence of CTP implementation on the TLTH outcome
THROMBOEMBOLIC AND BLEEDING RISK ASSESSMENT IN PATIENTS WITH NON-RHEUMATIC ATRIAL FIBRILLATION USING CHA2DS2-VASC AND HAS-BLED SCORING SYSTEMS
Procjenjuje se da od nereumatske atrijske fibrilacije (nAF) boluje 1ā2% svjetskog stanovniÅ”tva. NajÄeÅ”Äa komplikacija te aritmije jesu tromboembolijski dogaÄaji, meÄu kojima prednjaÄi ishemijski moždani infarkt. On je u bolesnika s nAF, u odnosu na bolesnike sa sinusnim ritmom, praÄen težim kliniÄkim tijekom, znaÄajno veÄom smrtnoÅ”Äu, a u preživjelih bolesnika znaÄajno sporijim oporavkom i težim trajnim duÅ”evnim i tjelesnim oÅ”teÄenjima. Primjena antikoagulantnog lijeÄenja u bolesnika s nAF znaÄajno smanjuje pojavnost ishemijskih moždanih infarkta, a u onih koji ga dožive tijekom njegove primjene poboljÅ”ava ishod lijeÄenja. Stoga smjernice struÄnih druÅ”tava preporuÄuju primjenu antikoagulantnog lijeÄenja u veÄine bolesnika s nAF. Istodobno, strah od krvarenja uzrokovanog antikoagulantnim lijeÄenjem uzrok je njegova, Äesto neopravdanog, neprimjenjivanja u bolesnika s velikim tromboembolijskim rizikom. U ovom radu prikazujemo sustave CHA2DS2-VASc i HAS-BLED, koji su preporuÄeni u procjeni tromboembolijskog rizika i rizika od krvarenja, prilikom odabira tromboprofilaktiÄkog lijeÄenja u bolesnika s nAF.It is estimated that approximately 1ā2% of the world population are affected with non-rheumatic atrial fibrillation (nAF). The most frequent complications of this arrhythmia are thromboembolic events, primarly ischemic stroke. In comparison with patients in sinus rhythm, stroke affected nAF patients have more severe clinical course and significantly higher mortality rate, and the survivors have significantly lower recovery rate and more serious permanent mental and physical impairments. The administration of anticoagulants to patients with nAF significantly reduces the incidence of stroke, while those who were stroke affected during the anticoagulant therapy show better treatment outcomes. Therefore, professional associations guidelines recommend the anticoagulant treatment for the majority of patients with nAF. The fear of bleeding caused by anticoagulants results in their frequently unjustified omission from the therapy in patients with high thromboembolic risk. This paper presents CHA2DS2-VASc- and HAS-BLED systems recommended for thromboembolic and bleeding risk assessment when deciding on thromboprophylactic therapy in patients with nAF
THROMBOPROPHYLAXIS IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION ADMITTED IN UNIVERSITY HOSPITAL SPLIT, CROATIA, DUE TO THE ISCHAEMIC STROKE IN RELATION TO THROMBOEMBOLIC AND BLEEDING RISK
Cilj rada bio je procijeniti usklaÄenost propisivanja tromboproilakse u bolesnika s nevalvularnom atrijskom ibrilacijom (nAF) prigodom prijma na lijeÄenje zbog ishemijskog moždanog infarkta sa smjernicama Europskog kardioloÅ”kog druÅ”tva za tromboproilaksu u bolesnika s nAF. U presjeÄno retrospektivno istraživanje je ukljuÄeno 327 bolesnika [143 (44 %) muÅ”karaca] s nAF, lijeÄenih zbog ishemijskog moždanog infarkta. Tromboembolijski (TE) rizik procijenjen je sustavom CHA2DS2-VASc, a rizik krvarenja sustavom HAS-BLED. Prije doživljenog ishemijskog moždanog infarkta 98,2 % bolesnika pripadalo je skupini velikog tromboembolijskog rizika. Od tog broja tromboproilaksu je primjenjivalo samo 179 (55 %) bolesnika: 65,5 % bolesnika primjenjivalo je acetilsalicilnu kiselinu, 30,5 % varfarin, a 4 % klopidogrel. Raniji tromboembolijski incident nezavisno je korelirao s primjenom (OR 2,5; 95% CI 1,4-4,5; p=0,003), a neregulirana arterijska hipertenzija s neprimjenjivanjem (OR 0,47; 95% CI 0,25-0,88; p=0,019) varfarina. Od 55 bolesnika koji su ishemijski moždani infarkt doživjeli unatoÄ primjeni varfarina, u 83,7 % bolesnika vrijednosti protrombinskog indeksa prilikom prijama su bile niže od terapijskih.Autori zakljuÄuju da tromboproilaksa u bolesnika s nAF hospitaliziranih zbog ishemijskog moždanog infarkta nije bila sukladna njihovom tromboembolijskom riziku i trenutnim smjernicama Europskog kardioloÅ”kog druÅ”tva.Aim of the study was to assess the concordance of the thromboprophylactic treatment in patients with nonvalvular atrial ibrillation (nAF) at the time of admission due to ischemic stroke with clinical guidelines of the European Society of Cardiology. Methods: In the cross-sectional study were included 327 patients [143 (44%) males] treated because of ischemic stroke associated with nAF. The index of the thromboembolic risk (TE) has been established by the CHA2DS2-VASc score, whereas the bleeding risk has been assessed by the HAS-BLED score. Results: Before the ischemic stroke, 98.2% of patients belonged to the group of high TE risk. Among these patients only 179 (55%) were received thromboprophylaxis: 67.5% patients acetylsalicylic acid, 30.5% warfarin, and 4% clopidogrel. Previous ischemic stroke was independently correlated with warfarin administration (OR 2.5; 95% CI 1.4-4.5; p=0.003), while poorly controlled arterial hypertension was independently correlated with warfarin non-administration (OR 0.47; 95% CI 0.25-0.88; p=0.019). The 83.7% of 55 patients, who experienced ischemic stroke during anticoagulant treatment, had an INR values lower than therapeutic. Conclusion: Thromboprophylaxis among the patients with nAF admitted because of ischemic stroke did not correlate with their TE risk and contemporary guidelines of the European Society of Cardiology
Dehiscence of a valved aortic conduit as a delayed complication of the blunt chest trauma
65-godiÅ”nji muÅ”karac s dakronskim tubularnim graftom uzlazne aorte i mehaniÄkim aortalnim zaliskom (ākompozitni graftā), zaprimljen je na NeuroloÅ”ki odjel zbog tranzitorne ishemijske atake. Sedam mjeseci prije ove hospitalizacije, doživio je prometnu ezgodu s tupom povredom prsiÅ”ta. Radiografijom prsnoga koÅ”a i ranstorakalnim ehokardiografskim pregledom uÄinjenim neposredno po nezgodi, nisu zabilježene patoloÅ”ke promjene. Prilikom prijama, bolesnik je bio bez simptoma, stabilnih hemodinamskih parametara.
UnatoÄ tome, ehokardiografskim pregledom je zabilježena hiscencija kompozitnog grafta aorte u podruÄju proksimalne anastomoze s posljediÄnim nastankom pseudoaneurizme u prostoru izmeÄu aortne stijenke i dakronskog grafta. Pseudoaneurizma je slobodno municirala s izlaznim traktom lijeve klijetke. Bolesnik je žurno upuÄen na kardiokirurÅ”ki zahvat. Nažalost, umro je naglom smrÄu, tijekom pripreme za operativni zahvat. Prikazani sluÄaj upuÄuje na to da je, zbog odgoÄenog nastajanja pseudoaneurizme i dehiscencije
dakronskog grafta, ehokardiografsko praÄenje poželjno u svih olesnika, prethodno podvrgnutih ārekonstrukciji po Bentalluā, tijekom nekoliko mjeseci nakon tupe povrede prsiÅ”ta.A 65-year old man with bileaflet mechanical aortic prosthesis and a Dacron tubular aortic graft was admitted at the Department of Neurology due to transient ischemic attack. Seven months before admission, he had suffered a car accident with blunt thoracic trauma. A chest X-ray and transthoracic echocardiogram performed at the time of the accident reported no abnormalities. At admission, he was presented as a asymptomatic, hemodynamically stable patient. However, echocardiography showed dehiscence of the valved aortic conduit from the native aortic annulus at the proximal anastomosis site, and free communication between the left ventricular outflow tract and the periconduit cavity. The patient was referred to a cardiac surgeon.
Unfortunately, he experienced sudden death before the scheduled operation. Our case suggests that, because of delayed development of pseudoaneurysm and conduit dehiscence, echocardiography follow-up is recommended in patients after Bentall reconstruction within several months after the blunt chest trauma
ANTICOAGULANT THERAPY IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION ā EVIDENCE BASED MEDICINE AND CLINICAL PRACTICE
Cilj istraživanja bio je procijeniti usklaÄenost propisivanja tromboprofilaktiÄkog lijeÄenja u bolesnika s permanentnom atrijskom fibrilacijom (pAF) s kliniÄkim smjernicama Europskoga kardioloÅ”kog druÅ”tva. U prospektivno presjeÄno istraživanje susljedno su ukljuÄena 674 bolesnika (59% muÅ”karaca) otpuÅ”tenih s kardioloÅ”kog odjela s dijagnozom pAF. Težina tromboembolijskog (TE) rizika procijenjena je CHA2DS2-VASc-sustavom, a rizik od krvarenja HAS-BLED-sustavom. U skupinu velikog TE rizika klasificirano je 578 (86%), umjerenog 57 (8%), a malog 39 (6%) bolesnika. Tromboprofilaksa je primijenjena u 601 (89%) bolesnika: varfarin u 310 (46%), acetilsalicilna kiselina u 258 (38%), a klopidogrel u 33 (5%). Varfarin je propisan u 47% bolesnika velikog, 49% bolesnika umjerenog te u 26% bolesnika malog TE rizika (P=0,03), a acetilsalicilna kiselina u 39% bolesnika malog, 39% bolesnika umjerenog i 38% bolesnika velikog TE rizika (P=0,998). Acetilsalicilna kiselina (P<0,001) i varfarin (P=0,007) bili su znaÄajno ÄeÅ”Äe koriÅ”teni u skupini bolesnika s velikim rizikom od krvarenja, u kojoj je zabilježena jednaka uÄestalost propisivanja varfarina i acetilsalicilne kiseline (53% prema 47%; P=0,416). Dob Ā³75 godina bila je nezavisni prediktor neprimjenjivanja (OR 1,7; 95% CI 1,2ā2,4; P=0,003), a anamneza moždanog infarkta primjenjivanja varfarina (OR 0,47; 95% CI 0,29ā0,76;P=0,002). Prilikom propisivanja tromboprofilaktiÄkog lijeÄenja bolesnicima s pAF lijeÄnici se ne pridržavaju preporuÄenih smjernica. UnatoÄ nepostojanju kontraindikacija znaÄajan udio bolesnika s velikim TE rizikom nije dobio varfarin. Istodobno, varfarin je propisivan bolesnicima s malim TE rizikom Äime su nepotrebno izloženi neželjenim uÄincima antikoagulantnog lijeÄenja.Objective of study was to assess the concordance of the tromboprophylactic treatment in patients with permanent atrial fibrillation (pAF) with guidelines of the European Society of Cardiology. Prospective cross-sectional study consecutivelly included 674 patients (400 Å 59%Ä male) discharged from cardiology department with the diagnosis pAF. The thromboembolic risk (TE) has been established according to CHA2DS2-VASc score, whereas the bleeding risk has been assessed according to HAS-BLED score. 578 (86%) belonged to the group of high, 57 (8%) to the group of moderate, and 39 (6%) patients to the group of low TE risk. 601 (89%) patients received thromboprophylaxis: 310 (46%) warfarin, 258 (38%) acetylsalicylic acid, and 33 (5%) patients clopidogrel. Warfarin has been prescribed to 47% of patients with high, 49% of patients with moderate and to 26% of patients with low TE risk (P=0.03). Acetylsalicylic acid (ASA) has equally been prescribed to patients of all TE risk groups: low, moderate and high (39% vs. 39% vs. 38%; P=0.998). ASA (P<0.001) and warfarin (P=0.007) have been used more frequently in the group of patients with high bleeding risk, in which the same incidence of warfarin and ASA administration has been registered (53% vs. 47%; P=0.416). Age Ā³75 has been an independent predictor of non-administration (OR 1.7; 95% CI 1.2ā2.4; P=0.003), whereas the history of stroke was for warfarin administration (OR 0.47; 95% CI 0.29ā0.76; P=0.002). In prescribing thromboprophylaxis to patients with pAF, cardiologists do not observe the recommended clinical guidelines. Despite nonexistence of contraindications, a significant number of patients with high TE risk has not been administered warfarin. At the same time, warfarin has been administered to the patients with low TE risk, exposing them unnecessarily to the undesired effect of anticoagulant treatment
Modern design of built-in cabinets
Rad ne sadrži sažetak
Prevention and treatment of postdural puncture headache with peroral thepohyline
Lumbalna punkcija (LP) uobiÄajena je neuroloÅ”ka procedura koja se rabi u dijagnostiÄke i u terapijske svrhe. Postpunkcijska glavobolja (PPG) razmjerno je Äesta popratna pojava lumbalne punkcije Äija se incidencija kreÄe u rasponu od 30% do 50% kod dijagnostiÄkih ili terapijskih lumbalnih punkcija, dok se tijekom provoÄenja epiduralne anestezije ukoliko se dogodi āincidentalniā ubod dure uÄestalost poveÄava do 80%. Upravo tako velika uÄestalost tog problema u svakodnevnoj kliniÄkoj neuroloÅ”koj praksi opravdava težnju brojnih kliniÄkih studija posveÄenih prevenciji PPG-a, ili smanjenju njezina intenziteta. ÄeÅ”Äe navoÄeni pripravci s potencijalnim uÄinkom na uÄestalost i intenzite PPG su lijekovi iz skupine metilksantina, posebice teofilin. Teofilin bi se kao lijek s dobro poznatim farmakodinamskim i farmakokinetskim svojstvima te predvidivim nuspojavama mogao vrlo jednostavno primjenjivati u prevenciji i/ili lijeÄenju PPG-a, a s obzirom na jednostavnost primijene tog lijeka PPG bi bilo moguÄe lijeÄiti i u izvanbolniÄkim uvjetima. Hipotetski, teofilin kompetitivnom neselektivnom inhibicijom fosfodiesteraze, neselektivnim antagonistiÄkim djelovanjem na adenozinske receptore te interferiranjem s unosom kalcija u sarkoplazmatsku mrežicu smanjuje kompenzatornu venodilataciju. Osim toga, teofilin stimuliranjem natrijsko-kalijske pumpe uzrokuje poveÄano stvaranje likvora. Prikazanim mehanizmima teofilin djeluje na dva osnovna prihvaÄena patofizioloÅ”ka mehanizma nastanka PPG-a, Å”to bi trebalo rezultirati rjeÄom pojavom i slabijim intenzitetom PPG-a.
Provedeno je dvostruko slijepo randomizirano istraživanje u skupini hospitaliziranih pacijenata u kojih je postavljena indikacija za dijagnostiÄku lumbalnu punkciju (LP) zbog sumnja na demijelinizacijsku bolest srediÅ”njeg ili perifernog živÄanog sustava. Ispitivana je populacija oba spola (27 žena i 12 muÅ”karaca) u dobi od 18 do 50 godina. Ispitanici su, nakon potpisivanja informiranog pristanka, randomizirani u dvije skupine. Njih 17 je (44%) primalo placebo,a 22 (56%) su peroralno primala 300 mg teofilina u obliku tablete s produljenim oslobaÄanjem dvaput na dan tijekom pet dana uzastopno. Ispitanici su Äetiri puta dnevno , poÄevÅ”i od prvog dana 30 minuta prije LP-a , procjenjivali intenzitet eventualne glavobolje prema vizualno-analognoj ljestvici (VAS-u). Osim toga, ispitanici su bilježili eventualnu pojavu muÄnine, i to prema VAS-u te prema upitniku Oweral nausea index
( ONI).
Osim Å”to je prvog dana praÄenja zabilježena statistiÄki znaÄajna razlika u uÄestalosti glavobolje izmeÄu dviju ispitnih skupina, tijekom daljnjeg praÄenja nije zamijeÄena statistiÄki znaÄajna razlika izmeÄu tih skupina. U objema je ispitivanim skupinama uoÄena razlika u intenzitetu glavobolje petog dana u odnosu prema drugom, treÄem i Äetvrtom danu praÄenja. To opažanje s jedne strane tumaÄimo moguÄim spontanim povlaÄenjem simptoma, Å”to se i inaÄe opaža u nekih bolesnika, no u velikog dijela ispitanika smanjenje intenziteta PPG-a povezujemo s Äinjenicom da je protokol istraživanja dopuÅ”tao uzimanje nesteroidnih analgetika ako bude potrebno. Nije uvrÄena statistiÄki znaÄajna razlika u broju ispitanika s muÄninom s obzirom na primijenjenu terapiju mjereno prema VAS ljestvici, a ni statistiÄki znaÄajna razlika u broju ispitanika s muÄninom s obzirom na primijenjenu terapiju mjereno prema ONI ljestvici. U ispitanika koji su osjeÄali muÄninu nije utvrÄena statistiÄki znaÄajna razlika u njezinu intenzitetu mjereno prema VAS ljestvici, a ni prema ONI ljestvici s obzirom na primijenjenu terapiju.
Rezultati prikazanog istraživanja ne potvrÄuju tezu o uÄinkovitosti peroralno primijenjenog teofilina u prevenciji pojave PPG-a ni tezu o njegovoj uÄinkovitosti u lijeÄenju postojeÄeg PPG-a i prateÄe muÄnine.Lumbar puncture (LP) is a common neurological procedure used for the diagnostic and therapeutic purposes. Postdural puncture headache (PDPH) is a relatively common side effect of lumbar puncture with an incidence ranging from 30% to 50% in the case of a diagnostic or therapeutic lumbar puncture. However, if āincidentalā dural jab happens, the incidence rises to 80% during epidural anesthesia . A high frequency of this problem in clinical neurology justifies numerous clinical studies devoted to prevention of PDPH or reduction of its intensity.
One of the frequently investigated drugs is theophylline, a drug from the group of methylxanthines. Theophylline is a drug with well-known pharmacodynamic and pharmacokinetic properties, including its side effects, so it could be easily applied in the prevention and / or treatment of PDPH. Since it is very easy to apply theophylline orally, it can be used for PDPH treatment in outpatient facilities. Our research was conducted with a group of patients hospitalized in the Department of Neurology, Split University Hospital during the period from 1st May of 2011 untill 31st March of 2012. The indication for performing diagnostic LP was suspected demyelinating disease of the central or peripheral nervous system. There have been investigated subjects of both genders (27 females and 12 males) aged 18-50. Subjects were randomized into two groups. 17 (44%) patients were receiving placebo, whereas 22 (56%) were receiving orally 300 mg of theophylline as the extended release tablets twice a day for five consecutive days. Neither the patients nor the doctors who were prescribing the drug (or placebo), as well as researchers who have noted the results of the poll were aware of randomization until the end of the study. Using visual analog scale (VAS) in the range 0-10, subjects have been estimating its headache intensity four times a day - starting from 30 minutes before LP ā for the following five days. Furthermore, subjects noted the potential occurrence of nausea using VAS and the "Oweral nausea index" questionnaire (ONI).
The statistically significant difference between these groups, with regard to the headache frequency, was found only for the first day of treatment. During the follow-up, there were no statistically significant differences between the same groups.
In both groups, there was a difference in a headache intensity on the fifth day compared to the second, third and the fourth day. This could be due to the spontaneous withdrawal decreased intensity of PDPH associated with the intake of nonsteroid antiinflamatory drugs, which were allowed by the protocol.
Statistically significant difference was not found in the number of subjects with nausea with regard to applied therapy as indicated by VAS.Anyway, there was a significant difference found in the number of subjects with nausea with regard to applied therapy as indicated by the ONI scale. In subject who reported nausea, there was no significant difference in its intensity indicated by VAS or ONI scale with regards to applied therapy. The results do not confirm the hypothesis that orally administered theophylline is effective in prevention of PDPH. Also, the research does not verify the effectiveness of the thesis in treating existing PDPH and accompanying nausea