35 research outputs found

    Dijagnostička vrijednost citoloŔke punkcije tankom iglom kod tumora dojke

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    Breast cancer is the most frequently diagnosed cancer and the leading cause of death from cancer in women. The accuracy of diagnosis can be increased with a combination of clinical examination, imaging diagnostics, and fine needle aspiration cytology (FNAC) or core needle biopsy, also known as triple test. The aim of the study was to evaluate the sensitivity and specificity of FNAC in the diagnosis of breast tumors in our institution by correlating it with histopathology findings. We assessed the accuracy of 124 FNAC findings by comparing cytological diagnosis of breast masses with the diagnoses from histopathology reports obtained by surgery. Statistical analysis showed 95.1% accuracy, 97.7% sensitivity, 89.1% specificity, 95.5% positive predictive value and 94.2% negative predictive value of FNAC. Study results indicated that FNAC could be used as a highly reliable tool in the differential diagnosis of breast tumors, in combination with clinical and imaging findings, especially in developing countries with limited financial resources.Karcinom dojke je najčeŔći zloćudni tumor i vodeći uzrok smrti od zloćudne bolesti kod žena. Pravodobnost i točnost dijagnoze mogu se poboljÅ”ati kombinacijom kliničkog pregleda, radioloÅ”kih pretraga i citoloÅ”ke punkcije tankom iglom ili core biopsije. Istraživanje je provedeno kako bi se utvrdila osjetljivost i specifičnost citoloÅ”ke punkcije tankom iglom tumora dojke u odnosu na patohistoloÅ”ki nalaz. U istraživanje je uključeno 124 nalaza citoloÅ”ke punkcije tankom iglom tumora dojke koji su uspoređeni s patohistoloÅ”kim nalazom nakon kirurÅ”ke resekcije. Statistička analiza je pokazala točnost od 95,1%, osjetljivost od 97,7%, specifičnost od 89,1%, pozitivnu prediktivnu vrijednost od 95,5% i negativnu prediktivnu vrijednost od 94,2%. Istraživanje je pokazalo da se citoloÅ”ka punkcija tankom iglom može koristiti kao veoma pouzdana pretraga u diferencijalnoj dijagnozi tumora dojke, u kombinaciji s kliničkim pregledom i radioloÅ”kim pretragama, pogotovo u zemljama u razvoju s ograničenim materijalnim sredstvima

    Increase of Combat Eff ectiveness of Warships with the Introduction into Operation of WECDIS

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    This paper analyses the possibility of increasing combat eff ectiveness of warships with the introduction into operation of Warship Electronic Chart Display and Information System (WECDIS) on board ships. This navigation computer information system, which complies with the rules of the International Maritime Organization (IMO) and NATO STANAG 4564 (Standard Agreement 4564) helps the navigational offi cer in his daily work. Navigational offi cer has the ability to use diff erent tools and information necessary for the protection and effi cient use of a warship. The emergence of new technologies in the fi eld of warfare is in the most aspects of naval operations computerised and digitalised with the intent to build, display and allow manipulation with the Recognised Maritime Picture (RMP). It is therefore surprising that a lot of Navies are still navigating using only paper charts although the advantages and effi ciency provided by the WECDIS, if used correctly, are signifi cant. In the fi rst part of the paper WECDIS is analysed as a navigational system used on warships with all the advantages and disadvantages recognised during its use in navigation. In the second part an increase of the combat eff ectiveness of warships during execution of diff erent warfare operation is analysed

    NIJEMI AKUTNI INFARKT MIOKARDA KOD BOLESNIKA SA ŠEĆERNOM BOLESTI U IZVANBOLNIČKOJ HITNOJ MEDICINI

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    Aim of the Study: Silent acute myocardial infarction occurs commonly in diabetic patients. Currently, it is not fully understood whether altered perception of ischemia also predisposes atypical presentations, and therefore leads to under-diagnosing the acute myocardial infarction (AMI) in diabetic patients. In this study, we tried to determine whether chest pain in AMI occurred less frequently in diabetic patients. Methods: In this retrospective study, we included patients admitted from April 2014 to November 2019. Data were collected using eHitna and BIS as the nation-wide programs for patient tracking and registry in Croatia. All patients included in the study had initially called Department of Emergency Medicine of Brod-Posavina County, which then resulted in an intervention. Patients were then transferred to Dr Josip Benčević General Hospital, where they were hospitalized. All patients had discharge letters with the diagnosis speciļ¬ ed by ICD-10 classiļ¬ cation as I21 spectrum (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), i.e. AMI. Results: In this study, we included 180 patients having suffered AMI who were hospitalized and treated. There were 35 (19%) diabetic patients (DP) and 145 (81%) non-diabetic patients (non-DP). Chest pain was absent in nine (26%) DP and 13 (9%) non-DP (p=0.007). There was no difference in sex distribution within the two groups, with 60% and 68% male patients in DP and non-DP, respectively (p=0.395). The mean patient age was signiļ¬ cantly different between the two groups, i.e. 69 years in DP and 64 years in non-DP (p=0.034). Discussion: AMI in diabetic patients could have altered clinical presentation, which has often been researched therefore. Some researchers have reported that atypical or silent presentations are more frequent in DP with AMI, whereas others found no differences when compared to non-DP. In our study, absence of chest pain as a characteristic of silent AMI was experienced by 17% more DP as compared to non-DP, suggesting that DM inļ¬‚ uences clinical presentation of AMI. It is important to emphasize the importance of such ļ¬ ndings in emergency medicine where patients often describe their various symptoms. The mean age of DP having suffered AMI was signiļ¬ cantly higher (even up to 5 years) in comparison to non-DP. Despite the fact that DM is a risk factor for developing AMI, this ļ¬ nding could be explained by the fact that DM is more common in elderly population. Conclusion: Chest pain occurs signiļ¬ cantly less frequently in DP that develop AMI than in non-DP. Therefore, DP have a higher probability of developing silent AMI.Cilj: Nijemi akutni infarkt miokarda (AIM) se pojavljuje čeŔće u bolesnika s dijabetesom. Predisponira li izmijenjena percepcija ishemije atipičnu prezentaciju te se zbog toga nedovoljno dijagnosticira AIM u bolesnika s dijabetesom, nije joÅ” dovoljno istraženo. U ovoj studiji pokuÅ”ali smo utvrditi pojavljuje li se bol u prsiÅ”tu kod AIM rjeđe kod bolesnika s dijabetesom. Metode: U ovu retrospektivnu studiju uključili smo bolesnike primljene od travnja 2014. do studenoga 2019. godine. Koristili smo bazu podataka programa ā€œe-hitnaā€ i ā€œBISā€ te sakupljali i analizirali podatke o bolesnicima koji su zatražili intervenciju izvanbolničke hitne medicinske službe u naÅ”oj županiji, bili prevezeni u Opću bolnicu ā€œDr. Josip Benčevićā€, hospitalizirani te im je kao otpusna dijagnoza postavljena prema klasiļ¬ kaciji MKB-10 bila u spektru dijagnoze I21 (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), tj. AIM. Dijabetes je zabilježen kod bolesnika koji su bili na inzulinu ili oralnim hipoglikemicima, uključujući dijabetes tip 1 i tip 2. Rezultati: U studiju smo uključili 180 bolesnika koji su doživjeli AIM. Od tog broja ih je 35 (19,4 %) imalo dijabetes (DP), a 145 (80,6 %) nije imalo dijabetes (ne-DP). Bol u prsiÅ”tu nije bila prisutna u devet (26 %) DP i 13 (9 %) ne-DP (p=0,007). Nije bilo značajne razlike u distribuciji prema spolu ni u jednoj skupini bolesnika (p=0,35). MuÅ”karaca je bilo 60 % u DP i 68 % u ne-DP. Prosječna dob značajno se razlikovala u dvjema skupinama. U DP je prosječna dob bila 69 godina, a u ne-DP 64 godine (p=0,034). Rasprava: Akutni infarkt miokarda u bolesnika s dijabetesom može se prezentirati izmijenjenom kliničkom slikom i zbog toga se često istraživao. Neki istraživači su pokazali da je atipična ili nijema prezentacija infarkta čeŔća u bolesnika s dijabetesom, dok drugi nisu pronaÅ”li razlike u usporedbi s nedijabetičarima. U ovoj studiji smo primijetili da je izostanak boli u prsiÅ”tu kao karakteristika nijemog AMI učestaliji u dijabetičara s AIM. To dovodi do zaključka da dijabetes utječe na kliničku sliku AIM. Treba istaknuti važnost takvog rezultata u izvanbolničkoj hitnoj medicini gdje se bolesnici često prezentiraju raznim simptomima. Srednja vrijednost dobi dijabetičara koji su doživjeli AIM bila je značajno veća nego u nedijabetičara. Unatoč činjenici da je dijabetes rizični čimbenik za razvoj AIM, ovaj rezultat možemo tumačiti činjenicom da je dijabetes zastupljeniji u starijoj populaciji. Zaključak: Bol u prsiÅ”tu se javlja rjeđe u bolesnika s dijabetesom koji imaju AIM nego u onih koji nemaju dijabetes. Zbog toga dijabetičari imaju veće izglede da razviju nijemi AIM.

    Prikladni alati za procjenu kronične boli u kliničkoj praksi

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    The aim of the study was to show the role of tools in the evaluation of chronic pain (CP) in general practitioner (GP) everyday clinical practice. The study was done by analyzing electronic database of the first visits of 1090 CP patients referred to the Pain Clinic of the Karlovac General Hospital, Karlovac, Croatia, by their GPs. All patient records were analyzed according to the cause of CP, strongest pain a week before the examination, quality of sleep, and the Patientsā€™ Global Impression of Change scale. All statistical analyses were done using the IBM SPSS Statistics version 19.0.0.1 (www.spss.com). CP predominantly occurs in older age group. Patients with musculoskeletal pain accounted for the highest percentage (n=316; 29%), followed by those with neuropathic pain (n=253; 23.20%) and those with low back pain (n=225; 20.60%). The mean pain intensity rating scale score was 8.3Ā±1.8 a week before the examination and the mean quality of sleep score was 6.8Ā±1.9. Moderate and severe sleep quality disorder was significantly present in patients over 65 years of age (p=0.007), patients with musculoskeletal and neuropathic pain, back pain, and those having rated Patientsā€™ Global Impression of Change scale as worsening (p=0.001). The severity of pain and poor quality of sleep are the leading causes of deterioration of the Patientsā€™ Global Impression of Change scale in patients suffering from musculoskeletal and neuropathic pain. In order to treat CP comprehensively, it is important for GPs to evaluate the outcomes of clinical treatment using tools for CP assessment.Cilj istraživanja bio je pokazati ulogu alata za procjenu kronične boli u svakodnevnoj kliničkoj praksi obiteljskog liječnika. Istraživanje je provedeno analizom elektroničke baze podataka prvog pregleda 1090 bolesnika s kroničnom boli upućenih od obiteljskog liječnika u Ambulantu za bol Opće bolnice Karlovac, Karlovac, Hrvatska. Za sve bolesnike analizirani su uzrok kronične boli, najjača bol tjedan dana prije pregleda, kvaliteta sna i ljestvica općeg dojma bolesnika o promjeni. Statistička analiza je učinjena pomoću programa IBM SPSS Statistics ver. 19.0.0.1 (www.spss.com). Kronična bol se pretežito javlja u starijoj dobnoj skupini. Najzastupljeniji su bili bolesnici s miÅ”ićno-koÅ”tanom boli (n=316; 29%), potom oni s neuropatskom boli (n=253; 23,20%) i oni s bolnim leđima (n=225; 20,60%). Srednja najjača bol (Pain Intensity Rating Scale, PI-NRS) tjedan dana prije pregleda bila je 8,3Ā±1,8, a kvaliteta sna 6,8Ā±1,9. Srednje jaki i jaki poremećaj kvalitete sna značajnije je prisutan kod bolesnika iznad 65 godina starosti (p=0,007), bolesnika s miÅ”ićno-koÅ”tanom, neuropatskom boli i bolnim leđima te onih koji su prema ljestvici općeg dojma bolesnika o promjeni ocijenili kao pogorÅ”anje (p=0,001). Jačina boli i loÅ”a kvaliteta sna bili su vodeći uzrok pogorÅ”anja prema ljestvici općeg dojma bolesnika o promjeni za bolesnike koji boluju od miÅ”ićno-koÅ”tane i neuropatske boli. Radi sveobuhvatnog liječenja važno je da obiteljski liječnici procijene ishode kliničkog liječenja alatima za procjenu kronične boli

    GENDER DIFFERENCES IN THE INCIDENCE AND CLINICAL PRESENTATION OF ACUTE MYOCARDIAL INFARCTION IN EMERGENCY MEDICINE

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    Cilj: Glavni cilj ovog istraživanja bio je ispitati postoje li spolne razlike u učestalosti, dobnoj distribuciji i kliničkoj prezentaciji kod bolesnika s akutnim infarktom miokarda koji su zatražili intervenciju Hitne medicinske službe. Metode: Učinjena je retrospektivna analiza baze podataka naÅ”eg Zavoda za hitnu medicinu u razdoblju od travnja 2014. do listopada 2019. godine. Koristili smo program e-Hitna te uključili sve bolesnike s dijagnozom akutnog infarkta miokarda (I21 prema MKB- 10 klasifi kaciji). Za sve bolesnike analizirali smo nekoliko karakteristika: dob, spol, prisutnost Å”ećerne bolesti te tri kliničke karakteristike (bol u prsima, poremećaj svijesti, hemodinamska nestabilnost). Rezultati: Ukupno je uključeno 377 pacijenata s dijagnozom akutnog infarkta miokarda. MuÅ”karaca je bilo 219 (58,1 %), a žena 158 (41,9 %) (p < 0,001). Prosječna dob obolijevanja muÅ”karaca iznosila je 64 godine, a žena 73 godine (p<0,001). Nije zabilježena razlika u pojavnosti Å”ećerne bolesti između spolova (p=0,88). Å to se tiče kliničkih karakteristika bolesnika, nije zabilježena razlika u pojavnosti i jačini boli u prsima (p=0,07) te hemodinamske nestabilnosti (p=0,49) između muÅ”karaca i žena. Međutim, žene čeŔće imaju poremećaj svijesti (62,2 %) u odnosu na muÅ”karce (37,8 %) (p<0,01). Rasprava: Akutni infarkt miokarda čeŔći je u muÅ”karaca Å”to potvrđuju i brojne studije. NaÅ”e istraživanje pokazalo je da se infarkt miokarda javlja u starijoj dobi kod žena s razlikom prosječne dobi obolijevanja od čak 9 godina. Takva razlika tumači se drugačijim utjecajem rizičnih čimbenika na razvoj kardiovaskularnih bolesti između spolova te protektivnim djelovanjem estrogena u žena prije menopauze. Od navedenih kliničkih karakteristika poremećaj svijesti javlja se čeŔće u žena Å”to je u skladu s mnogim istraživanjima koja navode da žene čeŔće imaju atipične simptome. Zaključak: Kardiovaskularne bolesti se javljaju čeŔće u muÅ”karaca, ali su glavni uzrok smrti u oba spola. MuÅ”karci obolijevaju i do 10 godina ranije, ali spolne se razlike starenjem smanjuju. Potrebna su daljnja istraživanja o uzroku razlika u kliničkoj prezentaciji akutnog infarkta miokarda između spolova.The main objective of this study was to investigate whether there are gender differences in the incidence, age, distribution and clinical presentation of patients with acute myocardial infarction requiring emergency medical intervention. Retrospective analysis of the data base of our Department of Emergency Medicine from April 2014 to October 2019 was performed. We used the e-Hitna program and included all patients with acute myocardial infarction (I21 according to the ICD-10 classifi cation). For all patients involved, we analyzed the following characteristics: age, gender, presence of diabetes, and three clinical characteristics (chest pain, disorders of consciousness, and hemodynamic instability). A total of 377 patients with acute myocardial infarction were included. There were 219 (58.1%) men and 158 (41.9%) women (p<0.001). The average age of men and women was 64 and 73 years, respectively (p<0.001). There was no gender difference in the incidence of diabetes (p=0.88). Regarding clinical characteristics of patients, there was no difference in the incidence and severity of chest pain (p=0.07) and hemodynamic instability (p=0.49). However, women were found to be more likely to have a disorder of consciousness (62.2%) than men (37.8%) (p<0.01). In conclusion, acute myocardial infarction is more common in men, as confi rmed by numerous studies. Our study shows that myocardial infarction occurs in older women, with a 9-year difference in the average age. Such a difference is interpreted by different infl uence of risk factors for the development of cardiovascular diseases between the genders and the protective effect of estrogen in women before menopause. Of these clinical characteristics, consciousness disorders occur more frequently in women, which is consistent with numerous studies reporting that women have atypical symptoms more often. In conclusion, cardiovascular diseases occur more frequently in men, but are the leading cause of death in both genders. Men have myocardial infarction 10 years earlier on average, but gender differences are decreasing with age. Further studies on the cause of differences in the clinical presentation of acute myocardial infarction between genders are required
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