12 research outputs found
Salmonella Ovarian Abscess in Young Girl Presented as Acute Abdomen ā Case Report
Ovarian abscess in young sexually non-active girls can represent a diagnostic challenge. 15-years old girl was admitted
to the Clinic for Gynaecology and Obstetrics under the suspicion of torsion of an ovarian cyst. Her clinical status deteriorated
after the admission with development of acute abdomen. Laparoscopic exploration was performed and unilateral
ovarian abscess was found without involvement of other pelvic structures. The surgical proceedure was minimal
invasive for a young girl and Salmonella staleyville was isolated from pus. Solitary ovarian abscess can be of hematogenous
origin and the causative pathogens are different from pathogens usually involved in pelvic inflammatory disease.
To avoid later fertility problems it is of great importance to treat infections in pelvic region correctly according to the isolated
microorganism and that surgery is the least invasive
Acute viral respiratory infections among nursing home residents and members of staff
S staranjem prebivalstva se veÄa Å”tevilo oseb s kroniÄnimi obolenji, upadom mentalnih in motoriÄnih funkcij ter poslediÄno potrebo po institucionaliziranem varstvu. V Sloveniji prebiva v domovih starejÅ”ih obÄanov (DSO) okoli 5% prebivalcev. Zaradi starostnega upada imunskih zmožnosti, pridruženih obolenj in bivalnih posebnosti (bivanja veÄjega ranljivih Å”tevila oseb v skupnih prostorih) predstavljajo okužbe v DSO poseben problem. Okužbe dihal (AOD) so med najpogostejÅ”imi okužbami v DSO, predstavljajo tretjino vseh okužb v DSO, povezane so z najveÄjim Å”tevilom bolniÅ”niÄnih obravnav in tudi z najviÅ”jo smrtnostjo. Vodijo lahko v trajni upad fiziÄnih zmogljivosti starostnikov. Äetudi pogostost virusnih AOD s starostjo pada, lahko te potekajo s težjim kliniÄnim potekom - z znaki akutne okužbe spodnjih dihal (AOSD). Prepoznavanje AOD je lahko pri starostnikih v DSO, zaradi pogosto neznaÄilne kliniÄne slike, težavno. Poznavanje virusne etiologije in incidence AOD v DSO je pomembno, saj omogoÄa smiselno na
rtovanje ukrepov za zmanjŔanje obolevnosti oskrbovancev.
Bolniki in metode
V 6-meseÄno prospektivno raziskavo smo vkljuÄili 90 oskrbovancev DSO ter 42 zaposlenih v enem izmed DSO-jev v mariborski regiji. Opazovali smo pojav AOD v obdobju od 5.decembra 2011 do 31. maja 2012 pri oskrbovancih DSO in osebju. AOD smo definirali po McGeer-ovih kriterijih. AOD so dnevno prepoznavale nauÄene medicinske sestre in potrdila zdravnica ob viziti pri obolelih oskrbovancih. Pridobili smo osnovne podatke, podatke o pridruženih obolenjih ter o cepljenju proti gripi pri vseh sodelujoÄih v raziskavi. Ob zaÄetku in zakljuÄku raziskave smo vsem sodelujoÄim odvzeli bris nosnega dela žrela za mikrobioloÅ”ke preiskave, prav tako tudi ob vsaki epizodi AOD, kjer smo zabeležili tudi kliniÄne simptome in znake obolenja.
V brisu nosnega dela žrela smo s pomoÄjo molekularne preiskave doloÄili prisotnost genoma virusov gripe A in B, parainfleunce 1-3, rinovirusov, respiratomega sincicijskega virusa, ÄloveÅ”kega metapnevmovirusa, koronavirusov, adenovirusov, ÄloveÅ”kega bokavirusa in enterovirusov. Prav tako smo v 6 meseÄnem obdobju raziskave beležili tedensko Å”tevilo obiskovalcev v sobah sodelujoÄih oskrbovancev DSO. V statistiÄni analizi smo uporabljali naslednje metode: 6-meseÄno incidenÄno stopnjo AOD, akutnih okužb zgornjih dihal (AOZD) in AOSD smo podali kot Å”tevilo AOD (oz. AOSD in AOZD) na 1000 oskrbnih dnikategoriÄne spremenljivke smo primerjali s pomoÄjo hi-kvadrat testa ali Fisherjevega eksaktnega testakorelacijo med spremenljivkama smo preuÄili s pomoÄjo korelacijskega koeficienta Kendall Ļs pomoÄjo multivariantne Poissonove analize smo preuÄili vpliv razliÄnih neodvisnih spremenljivk na incidenÄno stopnjo AOD pri posameznem oskrbovancu DSO. Povezanost med Å”tevilom obiskovalcev pri posameznih oskrbovancih in pojavom AOD pri le-teh smo preuÄevali s pomoÄjo Poissonove regresije. Kot statistiÄno znaÄilne smo upoÅ”tevali rezultate, pri katerih je bil p < 0,05.
Rezultati
V 6-meseÄnem opazovalnem obdobju je bila incidenÄna stopnja AOD 3,8/1000 oskrbnih dni pri oskrbovancih in 5,9/1000 oskrbnih pri zaposlenih, razlika je statistiÄno pomembna. Starostniki so pogosteje obolevali z AOSD (73%), kot z AOZD (27%), med tem ko so zaposleni obolevali skoraj izkljuÄno za AOZD (97%). S pomoÄjo multivariantne Poissonove analize smo ugotovili, da nobena od vkljuÄenih neodvisnih spremenljivk (starost, cepilni status - cepljenje proti gripi, pomiÄnost in pridružena kroniÄna obolenja (sladkorna bolezen, srÄno-žilna, možgansko-žilna obolenja, kroniÄna pljuÄna obolenja, demenca) ne vpliva na pojav AOD pri oskrbovancih, z izjemo demence. Dementni bolniki so kar 2,5 krat redkeje obolevali z AOD. Prav tako Å”tevilo obiskovalcev ni vplivalo na pojav AOD pri oskrbovancih. Ugotovili smo korelacijo med tedensko incidenÄno stopnjo AOD pri zaposlenih in oskrbovancih. Viruse smo dokazali pri 60,7 % epizod AOD pri oskrbovancih DSO in pri 47,7 % epizod AOD pri zaposlenih. Pri osThe life expectancy has been increasing significantly in the last decades. People aged over 65 represented 17% of population of Slovenia and 5% of the elderly (about 19,500) resided in 96 long-term care facilities and nursing homes (NH). Ageing parallels with a decline of many functions and is accompanied by the increasing frequency of chronic illnesses, impaired mobility and the need for assistance in daily living. The inability to take care of oneself is a rather common reason for a decision to become a NH resident. Acute respiratory infections (ARI) are common among NH residents, representing about 1/3 of all infections, and are the most frequent reason for hospital admittance, and a significant cause of mortality. Nevertheless, the knowledge of infections with respiratory viruses in NH residents is incomplete. More information is available for the epidemic rather than for sporadic type of infections. Due to daily visitors and NH staff viral infections from the community can be introduced into the NH and affect residents with chronic illnesses, impaired consciousness, impaired mobility etc. In addition, scarce clinical symptoms combined with limited diagnostic facilities hamper the recognition of infections and consequently lead to delayed introduction of preventive measures.
Participants and methods
We accomplished a 6-months prospective surveillance study from 5 December 2011 to 31 May 2012 in a part of 208-bed three-floor NH in north-eastern Slovenia that encompassed 90 (43.3%) residents (i.e., 90/97 residents living in one of the sections of the NH), and 42/53 (79.2%) nursing care workers, who provided signed informed consent for participation. Nasopharyngeal swabs for virology studies were collected from all participants at the time of enrolment (5 December 2012) and at the end of the study (31 May 2012), as well as from each participant who developed ARI within the period of the study. Cases of ARI were defined according to McGeer criteria for infection surveillance in long-term care facilities. During the 6-months study period the detection of ARI was carried out daily by trained study nurses and the diagnosis was confirmed by a physician who conducted a physical examination in case of illness. Daily number of visitors (adults, schoolchildren and pre-school children, respectively) in each participantās room was recorded during study period.
Real-time PCR and real-time RT-PCR were performed detecting influenza A/B, adenovirus, parainfluenza viruses 1, 2 and 3, human rhinoviruses, respiratory syncytial virus, human metapneumovirus, human coronaviruses, human bocavirus in nasopharyngeal swab samples. Results were statistically analysed using chi-square test, Fisher exact test. Correlations were expressed using the Kendall Tau coefficient. Multivariate Poisson regression model was used for estimating the influence of independent variables on ARI incidence-rate.
Results
During the 6-months observational period 100 episodes of ARI were observed, 56 among residents and 44 among staff. The calculated incidence rate was 3.8 ARI/ 1000 persons-days for residents and 5.9 ARI/ 1000 persons-days for staff members. The weekly incidence rate of ARI in NH residents correlated with the weekly ARI incidence rate in NH staff. Using a multivariate Poisson model for the number of ARI occurrences, including age, influenza vaccination, mobility of residents and chronic underlying diseases as explanatory variables and controlling the length of exposure, we estimated that the relative incidence-rate ratio of ARI for patients without dementia was 2.5 times larger than that for patients with dementiathe other covariates were not statistically significantly associated with the number of ARI episodes. Respiratory viruses were detected in 55 out of 100 ARI episodes (55%): in 34/56 (60.7%) episodes of ARI in residents and in 21/44 (47.7%) cases of ARI in staff. Of 56 NH residents with ARI 41 (73.5%) fulfilled criteria for lower respiratory trac
Salmonella ovarian abscess in young girl presented as acute abdomen--case report [Salmonella ovarijski apsces u mlade djevojke sa slikom akutnog abdomena: prikaz sluÄajeva]
Ovarian abscess in young sexually non-active girls can represent a diagnostic challenge. 15-years old girl was admitted to the Clinic for Gynaecology and Obstetrics under the suspicion of torsion of an ovarian cyst. Her clinical status deteriorated after the admission with development of acute abdomen. Laparoscopic exploration was performed and unilateral ovarian abscess was found without involvement of other pelvic structures. The surgical procedure was minimal invasive for a young girl and Salmonella staleyville was isolated from pus. Solitary ovarian abscess can be of hematogenous origin and the causative pathogens are different from pathogens usually involved in pelvic inflammatory disease. To avoid later fertility problems it is of great importance to treat infections in pelvic region correctly according to the isolated microorganism and that surgery is the least invasive
Capnocytophaga canimorsus - an unusual cause of septic shock in a patient without a spleen
The paper describes the case of a 28-year-old patient without a spleen in whomhigh fever, vomiting, abdominal cramps, palpable purpura and peripheral cyanosis suddenly developed. Upon admission, he was in septic shock with multi-organ failure. He needed intubation, artificial ventilation and hemodynamic support. Blood culture samples grew gram-negative rods after four days of incubation, which were later identified as Capnocytophaga Canimorsus. In continuation, the differential diagnosis in patients without a spleen who suddenly develop a septic shock is discussed. The importance bf taking an exact exposure history to find the correct diagnosis is emphasized, including possible contacts with domestic animals.Opisan je primer 28-letnega moÅ”kega brez vranice, ki je nenadoma zbolel z visoko vroÄino, bruhanjem, krÄi v trebuhu, purpuro in periferno cianozo. Ob sprejemu je bil v septiÄnem Å”oku z odpovedjo veÄ organov. Bolnik je potrebovalintubacijo, umetno predihavanje in hemodinamsko podporo. V krvnih kulturah so po Å”tirih dneh inkubacije porasli po Gramu negativni bacili, ki smo jih kasneje identificirali kot Capnocytophaga canimorsus. V nadaljevanju je opisana diferencialna diagnoza pri bolnikih brez vranice, ki nenadoma zbolijo s septiÄnim Å”okom. Poudarjen je pomen natanÄnih podatkov o dejavnikih iz okolja pri postavitvi pravilne diagnoze, vkljuÄno z možnimi stiki z domaÄimi živalmi
Termoaktivne nitinolske kopÄe za primarno i sekundarno zatvaranje sternalnih osteotomija nakon kardiokirurÅ”kih zahvata - prvo iskustvo u Sloveniji
Although there has been a trend towards minimally invasive and sternum-sparing
procedures, median sternotomy is still a standard surgical approach in cardiac surgery. Many techniques
and innovations for closure of sternal osteotomy have been developed with contradictory results.
In this report, we present our first experience with the nitinol-made sternal closure system in the
primary, as well as secondary closure of sternal osteotomy. A small series of 20 patients had their
sternotomy closed with Flexigrip clips. In one case, the Flexigrip clips were used in secondary wound
closure in a patient with deep sternal wound infection after full sternotomy and coronary bypass surgery.
After 6-month follow-up, all patients were doing well with their sternums clinically stable and
the sternotomy wounds completely healed. In conclusion, Flexigrip clips offered a stable alternative to
steel wires in primary, as well as secondary sternal closure. Moreover, in secondary sternal closure, the
thermoactive clips offered safety advantages over the standard wire cerclage technique because the
need for dissection of the substernal adhesions could be avoided.Iako postoji trend primjene minimalno invazivnih procedura s oÄuvanjem sternuma, medijana sternotomija je joÅ” uvijek
standardni kirurŔki pristup u kardiokirurgiji. Mnogo je tehnika i inovacija za zatvaranje sternalne osteotomije dosad razvijeno
s proturjeÄnim rezultatima. U ovom izvjeÅ”Äu iznosimo naÅ”e prvo iskustvo sa sustavom sternalnog zatvaranja napravljenog
od nitinola u primarnom kao i u sekundarnom zatvaranju sternalne osteotomije. Maloj seriji od 20 kardiokirurŔkih bolesnika
sternotomija je bila zatvorena kopÄama Flexigrip. Kod jednog bolesnika kopÄe Flexigrip koriÅ”tene su za sekundarno zatvaranje
rane u sluÄaju duboke infekcije sternalne rane nakon pune sternotomije i operacije koronarnog premoÅ”tenja. Nakon
6-mjeseÄnog praÄenja svi bolesnici bili su dobro, njihovi sternumi su bili kliniÄki stabilni, a rane od sternotomije bile su zacijeljene.
KopÄe Flexigrip su nudile stabilnu alternativu ÄeliÄnim žicama u primarnom kao i u sekundarnom zatvaranju sternuma.
Povrh toga, kod sekundarnog zatvaranja sternuma termoaktivne kopÄe imale su sigurnosne prednosti u odnosu na
standardnu tehniku serklaže žicom, jer se mogla izbjeÄi potreba za disekciju supsternalnih adhezija
Forecasting COVID-19
The World Health Organization declared the coronavirus disease 2019 a pandemic on March 11th, pointing to the over 118,000 cases in over 110 countries and territories around the world at that time. At the time of writing this manuscript, the number of confirmed cases has been surging rapidly past the half-million mark, emphasizing the sustained risk of further global spread. Governments around the world are imposing various containment measures while the healthcare system is bracing itself for tsunamis of infected individuals that will seek treatment. It is therefore important to know what to expect in terms of the growth of the number of cases, and to understand what is needed to arrest the very worrying trends. To that effect, we here show forecasts obtained with a simple iteration method that needs only the daily values of confirmed cases as input. The method takes into account expected recoveries and deaths, and it determines maximally allowed daily growth rates that lead away from exponential increase toward stable and declining numbers. Forecasts show that daily growth rates should be kept at least below 5% if we wish to see plateaus any time soonāunfortunately far from reality in most countries to date. We provide an executable as well as the source code for a straightforward application of the method on data from other countries
Predpisovanje perioperativne antibiotiÄne zaÅ”Äite v Sloveniji - vloga edukacije pri izboljÅ”anju predpisovanja
Viral respiratory infections in a nursing home: a six-month prospective study
Abstract Background The knowledge on viral respiratory infections in nursing home (NH) residents and their caregivers is limited. The purpose of the present study was to assess and compare the incidence of acute respiratory infections (ARI) in nursing home (NH) residents and staff, to identify viruses involved in ARI and to correlate viral etiology with clinical manifestations of ARI. Methods The prospective surveillance study was accomplished in a medium-sized NH in Slovenia (central Europe). Ninety NH residents and 42 NH staff were included. Nasopharyngeal swabs were collected from all participants at enrollment (December 5th, 2011) and at the end of the study (May 31st, 2012), and from each participant that developed ARI within this timeframe. Molecular detection of 15 respiratory viruses in nasopharyngeal swab samples was performed. Results The weekly incidence rate of ARI in NH residents and NH staff correlated; however, it was higher in staff members than in residents (5.9 versus 3.8/1,000 person-days, Pā=ā0.03), and was 2.5 (95Ā % CI: 1.36ā4.72) times greater in residents without dementia than in residents with dementia. Staff members typically presented with upper respiratory tract involvement, whereas in residents lower respiratory tract infections predominated. Respiratory viruses were detected in 55/100 ARI episodes. In residents, influenza A virus, respiratory syncytial virus, and human metapneumovirus were detected most commonly, whereas in NH staff rhinovirus and influenza A virus prevailed. 38/100 ARI episodes (30/56 in residents, 8/44 in staff) belonged to one of three outbreaks (caused by human metapneumovirus, influenza A virus and respiratory syncytial virus, respectively). NH residents had higher chances for virus positivity within outbreak than HN staff (ORā=ā7.4, 95Ā % CI: 1.73ā31.48, Pā<ā0.01). Conclusions ARI are common among NH residents and staff, and viruses were detected in a majority of the episodes of ARI. Many ARI episodes among NH residents were outbreak cases and could be considered preventable. Trial registration The study was registered on the 1th of December 2011 at ClinicalTrials ( NCT01486160 )