Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice : A critical assessment and summary of the Clinical Practice Guidelines

Peer reviewedPostprin

Quality of life in adults with cystic fibrosis: the Greek experience

INTRODUCTION: Recent developments in treatment have steadily raised the median predicted age of survival for people with Cystic Fibrosis (CF). We report the health-related quality of life (HRQoL) in CF adult patients and correlate our findings with the patients’ demographic characteristics. MATERIAL AND METHODS: The Cystic Fibrosis Quality of Life (CFQoL) questionnaire was answered by 77 CF adult patients. The questionnaire included questions pertaining to age, sex and level of education and covered eight sections of functioning. RESULTS: The highest score was reported in the “Social Functioning” section, while the lowest in the “Concerns for the Future” section. When different age groups were compared, statistical significances were reported in “Physical Functioning”, “Interpersonal Relationships”, and the “Career Concerns” section, with older patients reporting statistically higher HRQoL scores than younger ones (p < 0.005). No statistically significant difference was reported amongst the scoring between male and female CF patients. When different educational levels were compared, patients that had received a higher educational training scored statistically higher in all but one sections of the questionnaire when compared with patients of a lower educational level (p < 0.005). CONCLUSION: More than half Greek adult CF patients report that they are capable to participate in social activities but most of them are worried about the outcome of their disease and its effect on their lives.INTRODUCTION: Recent developments in treatment have steadily raised the median predicted age of survival for people with Cystic Fibrosis (CF). We report the health-related quality of life (HRQoL) in CF adult patients and correlate our findings with the patients’ demographic characteristics. MATERIAL AND METHODS: The Cystic Fibrosis Quality of Life (CFQoL) questionnaire was answered by 77 CF adult patients. The questionnaire included questions pertaining to age, sex and level of education and covered eight sections of functioning. RESULTS: The highest score was reported in the “Social Functioning” section, while the lowest in the “Concerns for the Future” section. When different age groups were compared, statistical significances were reported in “Physical Functioning”, “Interpersonal Relationships”, and the “Career Concerns” section, with older patients reporting statistically higher HRQoL scores than younger ones (p < 0.005). No statistically significant difference was reported amongst the scoring between male and female CF patients. When different educational levels were compared, patients that had received a higher educational training scored statistically higher in all but one sections of the questionnaire when compared with patients of a lower educational level (p < 0.005). CONCLUSION: More than half Greek adult CF patients report that they are capable to participate in social activities but most of them are worried about the outcome of their disease and its effect on their lives

Kardiopulmonalno oživljavanje: povijesni pregled od početka do kraja XIX. stoljeća

Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open- and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine’s most widely used fields.Društveni zakoni i religijska vjerovanja tijekom povijesti ogledalo su skokovitog razvoja znanosti oživljavanja od starine do danas. Pokušaji oživljavanja idu daleko u povijest, kada se smrt smatrala posebnim oblikom sna, odnosno Božjom voljom. Brojni su biblijski primjeri pokušaja oživljavanja. U srednjem je vijeku, međutim, oživljavanje bilo zabranjeno da bi posloje u renesansi takve zabrane kardiopulmonalnog oživljavanja bile stavljene pod pitanje te da bi konačno u doba prosvjetiteljstva znanstvenici pokušali riješiti problem nagle smrti. Upravo su se u to doba prvi put osvijestili različiti dijelovi kardiopulmonalnog oživljavanja poput ventilacije, cirkulacije, struje i organizacije hitnih službi. U XIX. se stoljeću naglo razvila ventilacijska potpora (inovacijama u intubaciji i umjetnim plućima) te potpora za otvorenu i zatvorenu cirkulaciju u prsnom košu. U međuvremenu su se razvile nove tehnike defibrilacije te je opisana ventrikulska fibrilacija. Dvadeseto stoljeće pak donosi važna otkrića koja su napokon dala znanstveni okvir kardiopulmonalnom oživljavanju. Godine 1960. sjedinjeni su disanje usta na usta s kompresijom prsnog koša i defibrilacijom, tj. onim što danas smatramo kardiopulmonalnim oživljavanjem. Ovaj se pregled osvrće na najvažnija mjesta u povijesti razvoja jednoga od najviše korišteni polja medicine

Kardiopulmonalno oživljavanje: povijesni pregled od početka do kraja XIX. stoljeća

Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open- and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine’s most widely used fields.Društveni zakoni i religijska vjerovanja tijekom povijesti ogledalo su skokovitog razvoja znanosti oživljavanja od starine do danas. Pokušaji oživljavanja idu daleko u povijest, kada se smrt smatrala posebnim oblikom sna, odnosno Božjom voljom. Brojni su biblijski primjeri pokušaja oživljavanja. U srednjem je vijeku, međutim, oživljavanje bilo zabranjeno da bi posloje u renesansi takve zabrane kardiopulmonalnog oživljavanja bile stavljene pod pitanje te da bi konačno u doba prosvjetiteljstva znanstvenici pokušali riješiti problem nagle smrti. Upravo su se u to doba prvi put osvijestili različiti dijelovi kardiopulmonalnog oživljavanja poput ventilacije, cirkulacije, struje i organizacije hitnih službi. U XIX. se stoljeću naglo razvila ventilacijska potpora (inovacijama u intubaciji i umjetnim plućima) te potpora za otvorenu i zatvorenu cirkulaciju u prsnom košu. U međuvremenu su se razvile nove tehnike defibrilacije te je opisana ventrikulska fibrilacija. Dvadeseto stoljeće pak donosi važna otkrića koja su napokon dala znanstveni okvir kardiopulmonalnom oživljavanju. Godine 1960. sjedinjeni su disanje usta na usta s kompresijom prsnog koša i defibrilacijom, tj. onim što danas smatramo kardiopulmonalnim oživljavanjem. Ovaj se pregled osvrće na najvažnija mjesta u povijesti razvoja jednoga od najviše korišteni polja medicine

Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock

The present work investigated the dynamic changes in stressed volume (Vs) and other determinants of venous return using a porcine model of hyperdynamic septic shock. Septicemia was induced in 10 anesthetized swine, and fluid challenges were started after the diagnosis of sepsis-induced arterial hypotension and/or tissue hypoperfusion. Norepinephrine infusion targeting a mean arterial pressure (MAP) of 65 mmHg was started after three consecutive fluid challenges. After septic shock was confirmed, norepinephrine infusion was discontinued, and the animals were left untreated until cardiac arrest occurred. Baseline Vs decreased by 7% for each mmHg decrease in MAP during progression of septic shock. Mean circulatory filling pressure (Pmcf) analogue (Pmca), right atrial pressure, resistance to venous return, and efficiency of the heart decreased with time (p < 0.001 for all). Fluid challenges did not improve hemodynamics, but noradrenaline increased Vs from 107 mL to 257 mL (140%) and MAP from 45 mmHg to 66 mmHg (47%). Baseline Pmca and post-cardiac arrest Pmcf did not differ significantly (14.3 ± 1.23 mmHg vs. 14.75 ± 1.5 mmHg, p = 0.24), but the difference between pre-arrest Pmca and post-cardiac arrest Pmcf was statistically significant (9.5 ± 0.57 mmHg vs. 14.75 ± 1.5 mmHg, p < 0.001). In conclusion, the baseline Vs decreased by 7% for each mmHg decrease in MAP during progression of hyperdynamic septic shock. Significant changes were also observed in other determinants of venous return. A new physiological intravascular volume existing at zero transmural distending pressure was identified, termed as the rest volume (Vr)

Current Challenges in the Management of Sepsis and Septic Shock: Personalized, Physiology-Guided Treatment

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection affecting millions of people each year [...