35 research outputs found
DijagnostiÄka vrijednost citoloÅ”ke punkcije tankom iglom kod tumora dojke
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 najÄeÅ”Äi zloÄudni tumor i vodeÄi uzrok smrti od zloÄudne bolesti kod žena. Pravodobnost i toÄnost dijagnoze mogu se poboljÅ”ati kombinacijom kliniÄkog pregleda, radioloÅ”kih pretraga i citoloÅ”ke punkcije tankom iglom ili core biopsije. Istraživanje je provedeno kako bi se utvrdila osjetljivost i specifiÄnost citoloÅ”ke punkcije tankom iglom tumora dojke u odnosu na patohistoloÅ”ki nalaz. U istraživanje je ukljuÄeno 124 nalaza citoloÅ”ke punkcije tankom iglom tumora dojke koji su usporeÄeni s patohistoloÅ”kim nalazom nakon kirurÅ”ke resekcije. StatistiÄka analiza je pokazala toÄnost od 95,1%, osjetljivost od 97,7%, specifiÄnost 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 kliniÄkim pregledom i radioloÅ”kim pretragama, pogotovo u zemljama u razvoju s ograniÄenim materijalnim sredstvima
Increase of Combat Eff ectiveness of Warships with the Introduction into Operation of WECDIS
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 Å EÄERNOM BOLESTI U IZVANBOLNIÄKOJ HITNOJ MEDICINI
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 BenÄeviÄ 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 ÄeÅ”Äe u bolesnika s dijabetesom. Predisponira li izmijenjena percepcija ishemije atipiÄnu 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 rjeÄe kod bolesnika s dijabetesom. Metode: U ovu retrospektivnu studiju ukljuÄili smo bolesnike primljene od travnja 2014. do studenoga 2019. godine. Koristili smo bazu podataka programa āe-hitnaā i āBISā te sakupljali i analizirali podatke o bolesnicima koji su zatražili intervenciju izvanbolniÄke hitne medicinske službe u naÅ”oj županiji, bili prevezeni u OpÄu bolnicu āDr. Josip BenÄeviÄā, 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, ukljuÄujuÄi dijabetes tip 1 i tip 2. Rezultati: U studiju smo ukljuÄili 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 znaÄajne 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. ProsjeÄna dob znaÄajno se razlikovala u dvjema skupinama. U DP je prosjeÄna 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 kliniÄkom slikom i zbog toga se Äesto istraživao. Neki istraživaÄi su pokazali da je atipiÄna ili nijema prezentacija infarkta ÄeÅ”Äa u bolesnika s dijabetesom, dok drugi nisu pronaÅ”li razlike u usporedbi s nedijabetiÄarima. U ovoj studiji smo primijetili da je izostanak boli u prsiÅ”tu kao karakteristika nijemog AMI uÄestaliji u dijabetiÄara s AIM. To dovodi do zakljuÄka da dijabetes utjeÄe na kliniÄku sliku AIM. Treba istaknuti važnost takvog rezultata u izvanbolniÄkoj hitnoj medicini gdje se bolesnici Äesto prezentiraju raznim simptomima. Srednja vrijednost dobi dijabetiÄara koji su doživjeli AIM bila je znaÄajno veÄa nego u nedijabetiÄara. UnatoÄ Äinjenici da je dijabetes riziÄni Äimbenik za razvoj AIM, ovaj rezultat možemo tumaÄiti Äinjenicom da je dijabetes zastupljeniji u starijoj populaciji. ZakljuÄak: Bol u prsiÅ”tu se javlja rjeÄe u bolesnika s dijabetesom koji imaju AIM nego u onih koji nemaju dijabetes. Zbog toga dijabetiÄari imaju veÄe izglede da razviju nijemi AIM.
Prikladni alati za procjenu kroniÄne boli u kliniÄkoj praksi
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 kroniÄne boli u svakodnevnoj kliniÄkoj praksi obiteljskog lijeÄnika. Istraživanje je provedeno analizom elektroniÄke baze podataka prvog pregleda 1090 bolesnika s kroniÄnom boli upuÄenih od obiteljskog lijeÄnika u Ambulantu za bol OpÄe bolnice Karlovac, Karlovac, Hrvatska. Za sve bolesnike analizirani su uzrok kroniÄne boli, najjaÄa bol tjedan dana prije pregleda, kvaliteta sna i ljestvica opÄeg dojma bolesnika o promjeni. StatistiÄka analiza je uÄinjena pomoÄu programa IBM SPSS Statistics ver. 19.0.0.1 (www.spss.com). KroniÄna bol se pretežito javlja u starijoj dobnoj skupini. Najzastupljeniji su bili bolesnici s miÅ”iÄno-koÅ”tanom boli (n=316; 29%), potom oni s neuropatskom boli (n=253; 23,20%) i oni s bolnim leÄima (n=225; 20,60%). Srednja najjaÄa 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 poremeÄaj kvalitete sna znaÄajnije je prisutan kod bolesnika iznad 65 godina starosti (p=0,007), bolesnika s miÅ”iÄno-koÅ”tanom, neuropatskom boli i bolnim leÄima te onih koji su prema ljestvici opÄeg dojma bolesnika o promjeni ocijenili kao pogorÅ”anje (p=0,001). JaÄina boli i loÅ”a kvaliteta sna bili su vodeÄi uzrok pogorÅ”anja prema ljestvici opÄeg dojma bolesnika o promjeni za bolesnike koji boluju od miÅ”iÄno-koÅ”tane i neuropatske boli. Radi sveobuhvatnog lijeÄenja važno je da obiteljski lijeÄnici procijene ishode kliniÄkog lijeÄenja alatima za procjenu kroniÄne boli
GENDER DIFFERENCES IN THE INCIDENCE AND CLINICAL PRESENTATION OF ACUTE MYOCARDIAL INFARCTION IN EMERGENCY MEDICINE
Cilj: Glavni cilj ovog istraživanja bio je ispitati postoje li spolne razlike u uÄestalosti, dobnoj distribuciji i kliniÄkoj prezentaciji kod bolesnika s akutnim infarktom miokarda koji su zatražili intervenciju Hitne medicinske službe. Metode: UÄinjena 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 ukljuÄili sve bolesnike s dijagnozom akutnog infarkta miokarda (I21 prema MKB-
10 klasifi kaciji). Za sve bolesnike analizirali smo nekoliko karakteristika: dob, spol, prisutnost Å”eÄerne bolesti te tri kliniÄke karakteristike (bol u prsima, poremeÄaj svijesti, hemodinamska nestabilnost). Rezultati: Ukupno je ukljuÄeno 377 pacijenata s dijagnozom akutnog infarkta miokarda. MuÅ”karaca je bilo 219 (58,1 %), a žena 158 (41,9 %) (p < 0,001). ProsjeÄna dob obolijevanja muÅ”karaca iznosila je 64 godine, a žena 73 godine (p<0,001). Nije zabilježena razlika u pojavnosti Å”eÄerne bolesti izmeÄu spolova (p=0,88). Å to se tiÄe kliniÄkih karakteristika bolesnika, nije zabilježena razlika u pojavnosti i jaÄini boli u prsima (p=0,07) te hemodinamske nestabilnosti (p=0,49) izmeÄu muÅ”karaca i žena. MeÄutim, žene ÄeÅ”Äe imaju poremeÄaj svijesti (62,2 %) u odnosu na muÅ”karce (37,8 %) (p<0,01). Rasprava: Akutni infarkt miokarda ÄeÅ”Äi je u muÅ”karaca Å”to potvrÄuju i brojne studije. NaÅ”e istraživanje pokazalo je da se infarkt miokarda javlja u starijoj dobi kod žena s razlikom prosjeÄne dobi obolijevanja od Äak 9 godina. Takva razlika tumaÄi se drugaÄijim utjecajem riziÄnih Äimbenika na razvoj kardiovaskularnih bolesti izmeÄu spolova te protektivnim djelovanjem estrogena u žena prije menopauze. Od navedenih kliniÄkih karakteristika poremeÄaj svijesti javlja se ÄeÅ”Äe u žena Å”to je u skladu s mnogim istraživanjima koja navode da žene ÄeÅ”Äe imaju atipiÄne simptome. ZakljuÄak: Kardiovaskularne bolesti se javljaju ÄeÅ”Äe 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 kliniÄkoj prezentaciji akutnog infarkta miokarda izmeÄu 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