Diagnostic procedures in children with urinary tract infections

Infekcije mokraćnog sustava (IMS) su značajan uzrok pobola s mogućim trajnim posljedicama i jedan su od najčešćih razloga primjene antimikrobnih lijekova. To je heterogena skupina bolesti obzirom na dob, spol, kliničku sliku, lokalizaciju upale i obzirom na prisutnost anomalija mokraćnog sustava. Infekcije mokraćnog sustava mogu biti simptomatske ili bez simptoma. Ponekad je samo prva infekcija simptomatska, a druge prolaze bez ili s vrlo malo simptoma. Ovo je vrlo važno znati u patogenezi bolesti jer i asimptomatske IMS mogu uzrokovati bubrežno oštećenje. Zamijećeno je da trećina djece s IMS ima anomaliju mokraćnog sustava. U dijagnostici IMS najvažniji je pregled urina pomoću probirnih testova (nitritni test, leukocitna esteraza), mikroskopskog pregleda sedimenta na leukocite (L) i bakterije te kultura urina. Kada se urin prikuplja vrećicom za urin i tehnikom ‘’srednjeg čistog mlaza’’ značajan je broj bakterija ≥105 CFU/mL, za urin uzet kateterom ≥103 CFU/mL, a za suprapubičnu aspiraciju značajan je svaki broj bakterija. Važni su i nalazi iz krvi: C-reaktivni protein, L i prokalcitonin. Slikovne pretrage u dijagnozi IMS su ultrazvuk mokraćnog sustava i statička scintigrafija bubrega Tc99mDMSA. Zlatni standard za dijagnozu akutne upale bubrežnog parenhima i ožiljnih promjena bubrega kod djece je statička scintigrafija bubrega.Urinary tract infections (UTI) make a significant count of infections in children with potentially permanent consequences. This is a heterogeneous group of diseases considering age, gender, clinical picture, localisation of infection and potential anatomy anomalies of urinary tract. Urinary tract infections can be symptomatic or asymptomatic. Sometimes, only the first infection is symptomatic, and others have none or few symptoms. The later can also cause renal injury. In diagnostics, the most important step is a urinalysis (nitrite tests and leukocyte esterase), microscopic exam of urine sediment (Leukocytes and bacteria), and urine culture. Depending on the sampling technique, significant bacteriuria is ≥105 CFU/mL for clean catch technique and midstream technique. For sampling using urine catheter, significant bacteriuria is ≥103 CFU/mL and for suprapubic aspiration technique, any count of bacteria is significant. Blood samples are also important: C-reactive protein, leukocytes, procalcitonin. Imaging methods in UTI are ultrasound of urinary tract and static scintigraphy of kidney with Tc99mDMSA. The golden standard for the diagnosis of acute pyelonephritis and kidney scars is static scintigraphy

BRUGADIN SINDROM UDRUŽEN S KORONARNOM SRČANOM BOLESTI

Brugada syndrome is a congenital disorder that can lead to sudden cardiac death. It is characterized by spontaneous or provoked typical ECG features and the occurrence of malignant ventricular arrhythmias, most commonly manifested by syncope or sudden death. The use of an implantable cardioverter-defi brillator is the only effective therapy for arrhythmic death prevention. The coexistence of Brugada syndrome and coronary heart disease is rarely described in the literature. We present a case of a patient with coexistence of two different heart conditions, symptomatic Brugada syndrome and coronary heart disease.Brugadin sindrom je nasljedni poremećaj koji može dovesti do iznenadne srčane smrti. Obilježen je spontanim ili provociranim tipičnim promjenama u EKG-u te pojavama malignih ventrikulskih aritmija koje se najčešće manifestiraju sinkopom ili iznenadnom smrću. Primjena implantabilnog kardioverter defi brilatora je jedina učinkovita terapija za sprječavanje aritmijske smrti. Koegzistencija Brugadina sindroma i koronarne bolesti je vrlo rijetko opisana u literaturi. Donosimo prikaz bolesnika s koegzistencijom dviju srčanih bolesti: simptomatskog Brugadina sindroma i koronarne bolesti

BRUGADIN SINDROM UDRUŽEN S KORONARNOM SRČANOM BOLESTI

Brugada syndrome is a congenital disorder that can lead to sudden cardiac death. It is characterized by spontaneous or provoked typical ECG features and the occurrence of malignant ventricular arrhythmias, most commonly manifested by syncope or sudden death. The use of an implantable cardioverter-defi brillator is the only effective therapy for arrhythmic death prevention. The coexistence of Brugada syndrome and coronary heart disease is rarely described in the literature. We present a case of a patient with coexistence of two different heart conditions, symptomatic Brugada syndrome and coronary heart disease.Brugadin sindrom je nasljedni poremećaj koji može dovesti do iznenadne srčane smrti. Obilježen je spontanim ili provociranim tipičnim promjenama u EKG-u te pojavama malignih ventrikulskih aritmija koje se najčešće manifestiraju sinkopom ili iznenadnom smrću. Primjena implantabilnog kardioverter defi brilatora je jedina učinkovita terapija za sprječavanje aritmijske smrti. Koegzistencija Brugadina sindroma i koronarne bolesti je vrlo rijetko opisana u literaturi. Donosimo prikaz bolesnika s koegzistencijom dviju srčanih bolesti: simptomatskog Brugadina sindroma i koronarne bolesti

The validity of minimally invasive surgery in treatment of lumbar spine degenerative disease

Objectives: To compare patients with lumbar spine degenerative disease treated by minimally invasive surgery using tubular retractor system and conventional surgical method. Study Design: Cross-sectional study with historical data. Patients and Methods: The single-institution series included 48 adult patients treated with one of the two surgical methods during a one-year period. The patients were divided between a case group consisting of minimally invasively treated patients and a control group of those operated on by conventional surgery. The research data were the following: age, gender, duration of symptoms, type of spinal pathology, type of surgical method, number of surgical levels treated, neurological status, pain intensity assessed by Visual Analogue Scale, duration of surgery and length of hospital stay. Modified Odom’s criteria were used as a primary outcome measure. All data were documented from electronic medical records, statistically analyzed, and correlated between The validity of minimally invasive surgery in treatment of lumbar spine degenerative disease the groups. The level of statistical significance was set at p<0.001. Results: A significant improvement of neurological status after surgery was recorded in all patients (case group, Fisher’s exact test, p=0.002, control group, Fisher’s exact test p=0.012). The pain intensity was significantly reduced after surgery in both groups (case group, Wilcoxon test, p<0.001, control group, Wilcoxon test, p<0.001). A statistically significant difference was observed between the case and the control group in the length of hospital stay (Mann-Whitney U test, p<0.001) and in time elapsed from surgery to patient mobilization (Mann-Whitney U test, p<0.001). In all other data examined, no statistically significant difference was noted between the case and control groups. Conclusion: Surgical treatment of lumbar spine degenerative disease results in significant improvement of neurological status and in reduced pain intensity. Minimally invasive surgery using tubular retractors results in shorter length of stay and earlier patient mobilization

Early Vital Indicators of Newborns Born After Medically Assisted Reproduction

Aim: In this case-control study we wanted to compare the perinatal outcome of naturally conceived newborns to those born after in vitro fertilization (IVF). Methods: At the University Hospital Centre Osijek, in the period from January 2014 to December 2016, we analysed 120 in vitro fertilization pregnancies and compared to 120 natural conception pregnancies. Characteristics of mothers, birth method, perinatal outcome, and vital characteristics of newborns were analysed. Results: IVF-ET pregnancies included 70.0% singleton pregnancies, 28.3% twin and 1.7% triplet pregnancies, while all naturally conceived pregnancies were singletons. When pregnancies were compared between IVF-ET and naturally conceived groups, the following characteristics of mothers were established: age 34.83 (5.8):30.39 (3.9); previous pregnancy 13.3%:56.7%; complications in pregnancy 50.0%:25.0%; Caesarean section (CS) 69.2%:35.8%. All of these were statistically significant (p < 0.001). Comparison of newborns between those two groups established the following: prematurity 39.5% vs. 12.7%; lowest BW 2,114 vs. 3,000 grams; lowest GA 22.29 vs. 28.71 weeks. In the IVF-ET group, 5.7% of newborns had a gestational age of 22-25 weeks, but there were no newborns of that gestational age among the naturally conceived newborns. These were also statistically significant differences (p < 0.001). Apgar score was 10 for both groups, but the difference was in the interquartile range, the values of which were lower in the IVF-ET group. Conclusion: In vitro fertilization pregnancies are high risk due to the characteristics of both the mother and the infant and, as such, require special attention and care. (Milas AM, Pušeljić S, Arambašić J, Šapina M, Tomac V. Early Vital Indicators of Newborns Born After Medically Assisted Reproduction. SEEMEDJ 2020; 4(2); 88-96

The role of direct oral anticoagulants in the era of COVID-19: are antiviral therapy and pharmacogenetics limiting factors?

In patients with COVID-19, thromboinflammation is one of the main causes of morbidity and mortality, which makes anticoagulation an integral part of treatment. However, pharmacodynamic and pharmacokinetic properties of direct oral anticoagulants (DOACs) limit the use of this class of anticoagulants in COVID-19 patients due to a significant interference with antiviral agents. DOACs use in COVID-19 hospitalized patients is currently not recommended. Furthermore, patients already on oral anticoagulant drugs should be switched to heparin at hospital admission. Nevertheless, outpatients with a confirmed diagnosis of COVID-19 are recommended to continue prior DOAC therapy. More studies are required to clarify the pathogenesis of COVID-19-induced derangement of the coagulation system in order to recommend an appropriate anticoagulant treatment