Prognostic Value of Venoarterial Carbon Dioxide Gradient in Patients with Severe Sepsis and Septic Shock

Aim To investigate the changes in the venoarterial carbondioxide gradient (V-a Pco2) and its prognostic value for survival of patients with severe sepsis and septic shock. Methods The study was conducted in General Hospital Holy Spirit from January 2004 to December 2007 and included 71 conveniently sampled adult patients (25 women and 46 men), who fulfilled the severe sepsis and septic shock criteria and were followed for a median of 8 days (interquartile range, 12 days). The patients were divided in two groups depending on whether or not they had been mechanically ventilated. Both groups of patients underwent interventions with an aim to achieve hemodynamic stability. Mechanical ventilation was applied in respiratory failure. Venoarterial carbon dioxide gradient was calculated from the difference between the partial pressure of arterial CO2 and the partial pressure of mixed venous CO2, which was measured with a pulmonary arterial Swan-Ganz catheter. The data were analyzed using Kaplan-Meier survival analysis, along with a calculation of the hazard ratios. Results There was a significant difference between nonventilated and ventilated patients, with almost 4-fold greater hazard ratio for lethal outcome in ventilated patients (3.85; 95% confidence interval, 1.64-9.03). Furthermore, the pattern of changes of many other variables was also different in these two groups (carbon dioxide-related variables, variables related to acid-base status, mean arterial pressure, systemic vascular resistance, lactate, body mass index, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology II Score, and Sepsis-related Organ Failure Assessment score). Pco2 values (with a cut-off of 0.8 kPa) were a significant predictor of lethal outcome in non-ventilated patients (P = 0.015) but not in ventilated ones (P = 0.270). Conclusion V-a Pco2 was a significant predictor of fatal outcome only in the non-ventilated group of patients. Ventilated patients are more likely to be admitted with a less favorable clinical status, and other variables seem to have a more important role in their outcome

Clinical and Anorectal Motility Features in Chronically Constipated Children

Constipation is a common problem in children. It can be a symptom of functional disorder in majority of cases, but sometimes a serious organic disease is a cause of constipation. Anorectal manometry plays an important role in the diagnostic procedure. It can be presumed that some values of manometric parameters could be very useful in treatment plan. The aim of this study was to confirm or exclude such limits in manometric finding, to make a plan of the therapy more accurate. Therefore the group of 81 constipated children was investigated. There were 58 patients suffering from functional constipation and 23 with organic disorders. The age of the patients was 3 to 15 years. Scoring system was applied to estimate severity of constipation and anorectal manometry was performed. Our results did not show significant correlation between clinical symptoms and signs and the values that we obtained using anorectal manometry. But, we recommend anorectal manometry because it is a safe method and contributes to clarify the diagnosis, which is very important for treatment plan

Clinical and Anorectal Motility Features in Chronically Constipated Children

Constipation is a common problem in children. It can be a symptom of functional disorder in majority of cases, but sometimes a serious organic disease is a cause of constipation. Anorectal manometry plays an important role in the diagnostic procedure. It can be presumed that some values of manometric parameters could be very useful in treatment plan. The aim of this study was to confirm or exclude such limits in manometric finding, to make a plan of the therapy more accurate. Therefore the group of 81 constipated children was investigated. There were 58 patients suffering from functional constipation and 23 with organic disorders. The age of the patients was 3 to 15 years. Scoring system was applied to estimate severity of constipation and anorectal manometry was performed. Our results did not show significant correlation between clinical symptoms and signs and the values that we obtained using anorectal manometry. But, we recommend anorectal manometry because it is a safe method and contributes to clarify the diagnosis, which is very important for treatment plan

Antimicrobial resistance of H. pylori to the outcome of 10-days vs. 7-days Moxifloxacin based therapy for the eradication: a randomized controlled trial

<p>Abstract</p> <p>Introduction</p> <p>Antibiotic resistance decreases success of Helicobacter pylori (Hp) eradication. Recently published results show low rate of resistance and better compliance with moxifloxacin based regiments.</p> <p>Aims&methods</p> <p>Whether 7 days moxifloxacin with lansoprasole and amoxycillin can be compared with 10 days moxifloxacin with lansoprasole and amoxycillin according to moxifloxacin resistance. Patients with non-ulcer dyspepsia who had culture and histology positive Hp infection (n = 150) were randomly assigned into two groups. The first group (n = 75) received moxifloxacin 400 mg/d during 7 days and the other (n = 75) received moxifloxacin 400 mg/d during 10 days. All patients received amoxycillin 1 g twice daily, lansoprasole 30 mg twice daily. All Hp cultures were tested for sensitivity to moxifloxacin.</p> <p>Results</p> <p>138 patients (92%) completed the study, 68 in the first group and 70 in the second. Eradication rates were 84% (57/68) and 76% (57/75) in the 7 days moxifloxacin group and 90% and 84% in the second group (63/70, 63/75) according to the PP and ITT analysis; p = n.s. Among 129 patients (86% of study group), 6% of strains were primary resistant to moxifloxacin.</p> <p>Eradication of moxifloxacin sensitive/resistant strains was 98%/66%, p < 0.05</p> <p>Conclusion</p> <p>According to our results we recommend 7 days moxiflixacin based triple therapy.</p

Prognostic Value of Venoarterial Carbon Dioxide Gradient in Patients with Severe Sepsis and Septic Shock

Aim To investigate the changes in the venoarterial carbondioxide gradient (V-a Pco2) and its prognostic value for survival of patients with severe sepsis and septic shock. Methods The study was conducted in General Hospital Holy Spirit from January 2004 to December 2007 and included 71 conveniently sampled adult patients (25 women and 46 men), who fulfilled the severe sepsis and septic shock criteria and were followed for a median of 8 days (interquartile range, 12 days). The patients were divided in two groups depending on whether or not they had been mechanically ventilated. Both groups of patients underwent interventions with an aim to achieve hemodynamic stability. Mechanical ventilation was applied in respiratory failure. Venoarterial carbon dioxide gradient was calculated from the difference between the partial pressure of arterial CO2 and the partial pressure of mixed venous CO2, which was measured with a pulmonary arterial Swan-Ganz catheter. The data were analyzed using Kaplan-Meier survival analysis, along with a calculation of the hazard ratios. Results There was a significant difference between nonventilated and ventilated patients, with almost 4-fold greater hazard ratio for lethal outcome in ventilated patients (3.85; 95% confidence interval, 1.64-9.03). Furthermore, the pattern of changes of many other variables was also different in these two groups (carbon dioxide-related variables, variables related to acid-base status, mean arterial pressure, systemic vascular resistance, lactate, body mass index, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology II Score, and Sepsis-related Organ Failure Assessment score). Pco2 values (with a cut-off of 0.8 kPa) were a significant predictor of lethal outcome in non-ventilated patients (P = 0.015) but not in ventilated ones (P = 0.270). Conclusion V-a Pco2 was a significant predictor of fatal outcome only in the non-ventilated group of patients. Ventilated patients are more likely to be admitted with a less favorable clinical status, and other variables seem to have a more important role in their outcome

Influence of Various Factors on Functional Dyspepsia

Aim of the research is to establish the prevalence of dyspepsia in Osjecˇko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric, and socioeconomic factors. It is a cross- sectional and case control study conducted in 2010 on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional dyspepsia (FD). The chi-square test, t-test and logistic regression were used for analysis. Prevalence of dyspepsia was recorded in 16, 56 %, of subjects. There is no statistically significant difference in prevalence of dyspepsia male and female. The prevalence of dyspepsia increases with age. Correlation with the place of birth was proven. There is no correlation between the current place of residence (rural area and town) and dyspepsia. There is a correlation with marital status. Correlation between stool forms was proven. There were a greater number of subjects that had at least one alarm symptom or some of the psychosocial factors and they often suffered from a chronic disease. The risk for dyspepsia increases with age, body mass index (BMI), and poorer health. Logistic regression showed the following as statistically significant for dyspepsia: place of birth and self-assessment of one’s health. FD presents a significant health problem. Rome III survey questionnaire proved to be an acceptable method for diagnosin this functional disorder in clinical-consilliary and primary health care for persons showing signs of alarm and needing further diagnostic treatment