Urinary bladder catheterization – modern approach

Kateterizacija je rutinski postupak kojim se omogućava drenaža urina iz mokraćnoga mjehura. Može se učiniti u dijagnostičke i terapijske svrhe. Postoji mnogo različitih katetera, a njihov izbor ovisi o razlogu njegova postavljanja. Kateteri za jednokratnu kateterizaciju obično su ravni, napravljeni od polivinil-klorida ili, ponekad, od lateksa. Trajni kateteri imaju retencijski mehanizam, a najčešće se koristi Foleyjev kateter (balon služi kao retencijski mehanizam). Kod dugotrajne kateterizacije preporučuje se korištenje Foleyjeva katetera od biokompatibilnog materijala. Silikonski kateteri, kao i oni obloženi hidrogelom, bolje se toleriraju nego oni proizvedeni od lateksa ili poliuretana. Potrebno je izabrati urinarni kateter najmanjega promjera, koji zadovoljava svrhu kateterizacije. Duljina kateterizacije mora biti što je kraće moguća. Otežana kateterizacija najčešće je prisutna kod muškaraca. Njezini uzroci mogu biti striktura uretre, uvećana prostata ili skleroza vrata mjehura. Otežana kateterizacija u žena prisutna je kod adipoznih osoba ili u slučaju kada se ne može pronaći vanjsko ušće uretre. Najčešća komplikacija vezana uz kateterizaciju je infekcija mokraćnoga sustava, koja sa sobom donosi značajan i morbiditet i mortalitet. To je inače i najčešći uzrok nozokomijalnih infekcija, čak do 40 %. Ostale moguće komplikacije su parafimoza, „lažni prolaz”, striktura uretre, perforacija uretre i krvarenje. Kateterizacija mokraćnoga mjehura u većine je pacijenata jednostavan postupak koji zbog mogućih popratnih komplikacija zahtijeva standardiziran pristup i provedbu.Catheterization is a routine medical procedure that facilitates direct drainage of the urinary bladder. It is used for both the diagnostic and therapeutic purposes. Many types of catheters are available for urethral catheterization, and the choice of a specific type of catheter depends on the reason for catheterization. The catheter for one-time catheterization is usually a straight catheter made from polyvynyl chloride or sometimes latex. For long-term catheterization catheters need a retention mechanism. Foley type catheters (balloon served as retention mechanism) are most often used for long-term urethral catheterization. If long-term catheterization is anticipated, it is advisable to use a Foley catheter made of the most biocompatible material. Catheters made of silicone or coated with hydrogel are, in general, better tolerated over the long-term than those made of materials like latex and polyurethane. In addition, one should choose the smallest urethral catheter that will accomplish the purpose of catheterization. The duration of catheterization must be as short as possible. Difficult catheterization is mostly seen in male patients. The most frequents causes are urethral stricture, prostatic enlargement and bladder neck contracture. Difficulty in catheterization of the female urethra is uncommon and usually results from extreme obesity and inability to locate the urethral meatus. The most frequent complication associated with catheterization is catheter-associated urinary tract infection resulting in significant morbidity and mortality. It is the most common nosocomial infection, comprising >40 % of all institutionally aquired infections. Other possible complications are paraphimosis, creation of false passage, urethral stricture, urethral perforation and bleeding. Catheterization is a routine procedure in the majority of patients but because of potential complications, performance must be standardized

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

TREATMENT OF PATIENTS WITH HYPERTENSIVE CRISIS IN EMERGENCY DEPARTMENT OF OPATIJA HEALTH CARE CENTER

Svrha istraživanja bila je utvrditi učestalost te značajke zbrinjavanja bolesnika s arterijskom hipertenzijom u službi izvanbolničke hitne medicinske pomoći. Uvidom u dokumentacijske listove 9677 bolesnika pregledanih tijekom 2001. godine u Centru za hitnu medicinsku pomoć Doma zdravlja Opatija izdvojeno je 727 bolesnika s povišenim arterijskim tlakom koji su svrstani u četiri skupine prema klasifikaciji povišenog arterijskog tlaka u hitnoj medicini. Prosječna dob pacijenata s arterijskom hipertenzijom bila je 66,5 godina. Hipertenzivnu krizu imala su 333 bolesnika (3,4%), uz najveću pojavnost u ranim večernjim satima, subotom te u proljetnim mjesecima (travanj). Bolesnici s hipertenzivnom emergencijom u pravilu su liječeni nitratom, a oni s urgencijom nifedipinom. Svih 175 bolesnika s hipertenzivnom emergencijom, nakon zapo~etog prehospitalnog liječenja, upućeno je u Hitnu medicinsku službu Kliničkoga bolničkog centra rijeka, a hospitalizirano je njih 122-je (69,7%). Bolesnici s hipertenzivnom urgencijom definitivno su zbrinuti prehospitalno. S obzirom na spoznaje o potencijalnim opasnostima uporabe nifedipina, za liječenje hipertenzivnih urgencija u službi izvanbolničke hitne pomoći preporučuje se primjena brzodjelujućeg ACE-inhibitora kaptoprila

TREATMENT OF PATIENTS WITH HYPERTENSIVE CRISIS IN EMERGENCY DEPARTMENT OF OPATIJA HEALTH CARE CENTER

Svrha istraživanja bila je utvrditi učestalost te značajke zbrinjavanja bolesnika s arterijskom hipertenzijom u službi izvanbolničke hitne medicinske pomoći. Uvidom u dokumentacijske listove 9677 bolesnika pregledanih tijekom 2001. godine u Centru za hitnu medicinsku pomoć Doma zdravlja Opatija izdvojeno je 727 bolesnika s povišenim arterijskim tlakom koji su svrstani u četiri skupine prema klasifikaciji povišenog arterijskog tlaka u hitnoj medicini. Prosječna dob pacijenata s arterijskom hipertenzijom bila je 66,5 godina. Hipertenzivnu krizu imala su 333 bolesnika (3,4%), uz najveću pojavnost u ranim večernjim satima, subotom te u proljetnim mjesecima (travanj). Bolesnici s hipertenzivnom emergencijom u pravilu su liječeni nitratom, a oni s urgencijom nifedipinom. Svih 175 bolesnika s hipertenzivnom emergencijom, nakon zapo~etog prehospitalnog liječenja, upućeno je u Hitnu medicinsku službu Kliničkoga bolničkog centra rijeka, a hospitalizirano je njih 122-je (69,7%). Bolesnici s hipertenzivnom urgencijom definitivno su zbrinuti prehospitalno. S obzirom na spoznaje o potencijalnim opasnostima uporabe nifedipina, za liječenje hipertenzivnih urgencija u službi izvanbolničke hitne pomoći preporučuje se primjena brzodjelujućeg ACE-inhibitora kaptoprila

The prevalence of supraventricular arrhythmias with regard to the type and degree of left ventricular hypertrophy in patients with hypertensive heart disease

OBJECTIVES: We investigated the correlation between the type and degree of left ventricular hypertrophy and the prevalence of supraventricular arrhythmias in patients with hypertensive heart disease. METHODS: The study included 179 patients (79 men, 100 women, aged 43–80 years, median 68 years) with left ventricular hypertrophy. Patients were classified into three groups (concentric, eccentric and asymmetric types of hypertrophy) and into three subgroups (mild, moderate and severe hypertrophy). After discontinuation of all medication for 48 h, blood pressure was measured, electrocardiography and echocardiography performed and the prevalence of supraventricular arrhythmias assessed using Holter monitoring and bicycle ergometry. Antihypertensive drugs and duration of previous treatment were taken into consideration. RESULTS: Atrial fibrillation or paroxysmal supraventricular tachycardia were found in 43% of patients. The analysis showed no significant correlation between the prevalence of atrial fibrillation and/or paroxysmal supraventricular tachycardia and the degree (P = 0.607) and type of left ventricular hypertrophy (P = 0.455). However, the frequency of supraventricular premature beats was higher in the concentric and eccentric types than in the asymmetric type (P = 0.048) and increased with the degree of hypertrophy (significantly in men with the concentric type, P = 0.015). CONCLUSION: Concentric and eccentric types of left ventricular hypertrophy have a greater impact on the frequency of atrial arrhythmias. In the concentric type the prevalence of supraventricular premature beats correlates with the degree of left ventricular hypertrophy. Patients with moderate and severe concentric and eccentric left ventricular hypertrophy should be always tested using Holter monitoring and bicycle ergometry and treated with the maximum tolerable doses of antihypertensives, particularly with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers

Water for all : proceedings 8th International Conference Water for all

The 8th International Conference WATER FOR ALL was held on the 21th and 22th March 2019 in Osijek, on Faculty of Civil Engineering and Architecture Osijek on the occasion of World Water Day and with the aim of gathering and exchanging experiences of scientists and experts in the field of water management, environmental protection and preservation of water resources. The Conference included plenary lectures, oral lectures, poster presentations, and the presentations of sponsoring companies. 8th International Conference WATER FOR ALL was organized by the Josip Juraj Strossmayer University of Osijek, Faculty of Food Technology Osijek and Faculty of Civil Engineering and Architecture Osijek, Croatian Chamber of Economy, Croatian Water - VGO, Croatian Chamber of Health Professionals, Croatian Water Pollution Control Society, Faculty of Agrobiotechnical Sciences Osijek, Department of Biology of the Josip Juraj Strossmayer University of Osijek, Department of Chemistry of the Josip Juraj Strossmayer University of Osijek, University of Bihać, Faculty of Agriculture and Food Technology University of Mostar, Faculty of Health Studies University of Sarajevo, Faculty of Food Technology and Biotechnology University of Zagreb, Faculty of Technology University of Tuzla, Faculty of Technology and Metallurgy University of Skopje, Faculty of Health Sciences University of Ljubljana, Nature Park “Kopački rit”, Public Institution for nature protection in Osijek- Baranja County, Public Health Institute of the Osijek-Baranja County, Health Center Osijek, Vodovod-Osijek d.o.o. and Alumni Association of former students and friends of the Faculty of Food Technology Osijek - TehnOS. The international co- organizers of the Conference were International Federation of Environmental Health (IFEH), European Hygienic Engineering & Design Group (EHEDG) and Danube Parks. The theme of World Water Day 2019 and 8th International Conference WATER FOR ALL was "Water for all – Leaving no one behind!". At the 8th International Conference WATER FOR ALL participated 359 authors from 10 countries (Croatia, Bosnia and Herzegovina, Serbia, Montenegro, Slovenia, Republic of Kosovo, Turkey, Norway, Mexico and Brazil) with presentation of in total 112 paper, from which of them 41 were presented orally, and were presented 71 as poster presentation. Abstract of the mentioned papers were published in the Book of Abstracts of the 8th International Conference WATER FOR ALL. The Scientific Committee of 8th International Conference WATER FOR ALL received 35 full papers for publication and 17 of them became the part of the this Proceedings, while 18 papers were accepted and publicated in following international scientific journals: Electronic Journal of the Faculty of Civil Engineering Osijek - e-GFOS, Croatian Journal of Food Science and Technology, Technologica Acta, The Holistic Approach to Environment and Environmental Engineering - Inženjerstvo Okoliša. Special contributions to the quality of this Proceedings of the 8th International Conference WATER FOR ALL were given by 49 reviewers, mostly university professors and professionals, from 10 countries and over twenty international universities, faculties and institutions. On behalf of the Organizing and Scientific Committee of the 8th International Conference WATER FOR ALL we cordially thank all the authors, participants, reviewers and sponsors for their contribution to the quality of the 8th International Conference WATER FOR ALL

Ružička days : International conference 18th Ružička Days “Today Science – Tomorrow Industry” : Proceedings

Proceedings contains articles presented at Conference divided into sections: chemical analysis and synthesis, chemical and biochemical engineering, food technology and biotechnology, medical chemistry and pharmacy, environmental protection and meeting of young chemists

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04-1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15-1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7-3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64-7.71) and mortality (RR=19.80; 95% CI, 5.87-66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants