Bohemian alternative: Otakar II. Přemysl and his reign in Styria, Carinthia and Carniola

Sredina 13. stol. je predstavljala kaotično obdobje v Svetem rimskem cesarstvu, v času katerega so številni nemški knezi nestabilnost izkoristili za širjenje lastnega vpliva in za ozemeljsko širitev. Eden izmed najuspešnejših vladarjev v tem obdobju je bil Otokar II. iz češke rodbine Přemyslidov. Smrt avstrijskega in štajerskega vojvode Friderika II. Prepirljivega, zadnjega moškega pripadnika rodbine Babenberžanov, je Otokar izrabil za širitev svoje vladavine proti jugu. Prišlo je do boja za nekdanje Babenberške posesti, pri čemer je Otokar, ki je bil od leta 1253 češki kralj, moral tekmovati z ogrskim kraljem Belo IV. Leta 1251 je bil v Avstriji s strani lokalnega plemstva imenovan za novega vojvodo. Za legitimizacijo njegove oblasti se je poročil z Margareto, sestro Friderika II. Prepirljivega. Leta 1254 je moral večji del Štajerske prepustiti svojemu ogrskem rivalu. Šest let kasneje je prišlo do upora štajerskega plemstva, kar je Otokar izkoristil za vojaški pohod proti Beli IV. Češki kralj je bil uspešen in je leta 1261 zavladal tudi na Štajerskem. Njegova vladavina je bila usmerjena v centralistično reformo administracije, pri čemer je poskušal zmanjšati vpliv in moč plemstva, opiral pa se je predvsem na duhovščino in meščanstvo. Otokar je leta 1269 po smrti njegovega bratranca Ulrika III. Spanheimskega, s katerim je sklenil pogodbo o dedovanju, svojo oblast razširil še na Kranjsko in Koroško. Velik del lokalnega plemstva njegove vladavine ni priznaval, zato je češki kralj ti dve deželi zavzel z vojaškim posredovanjem. Leta 1272 je bil na vrhuncu svoje moči in je pridobil tudi nadzor nad Furlanijo in Oglejskem patriarhatom. Začetek njegovega konca je bila izvolitev Rudolfa I. Habsburškega za novega nemškega kralja. Temu je uspelo združiti Otokarjeve nasprotnike, v očeh katerih je bila njegova vladavina nelegitimna. Ker se mu češki vladar ni želel pokoriti, je med njima leta 1276 prišlo do vojaškega konflikta. Otokar je bil poražen in je moral zapustiti nekdanje babenberške in spanheimske dežele. Dve leti pozneje je Otokar poskusil znova pridobiti izgubljena ozemlja, a je bil pri tem neuspešen in je svoje življenje 26. avgusta izgubil v bitki pri Dürnkrutu. S tem se je končalo obdobje, v katerem je bil velik del današnjega slovenskega ozemlja združen pod enim vladarjem.The mid-13th century was a chaotic period in the Holy Roman Empire, during which many German princes took advantage of the instability to expand their influence and for territorial expansion. One of the most successful rulers of this period was Otakar II of the Přemyslid dynasty. The death of Frederick II the Quarrelsome, the last male member of the Babenberg family, was used by Otakar to extend his rule southwards. There was a battle for the former Babenberg estates, where Otakar, who had been King of Bohemia since 1253, had to compete with King Béla IV of Hungary. In 1251, he was appointed the new Duke of Austria by the local nobility. To legitimise his power, he married Margaret, sister of Frederick II the Quarrelsome. In 1254, he had to leave most of Styria to his Hungarian rival. Six years later, there was a revolt of the Styrian nobility, which Otakar took advantage of to launch a military campaign against Béla IV. The Bohemian king was successful and ruled Styria in 1261. His reign was oriented towards a centralist reform of the administration, trying to reduce the influence and power of the nobility, relying mainly on the clergy and the bourgeoisie. In 1269, after the death of his cousin Ulrich III of Spanheim, with whom he had concluded a succession treaty, Otakar extended his rule to Carniola and Carinthia. Much of the local nobility did not acknowledge his rule, thus the King of Bohemia took these two lands by military intervention. In 1272, at the height of his power, he also gained control of Friuli and the Patriarchate of Aquileia. The beginning of the end for Otakar was the election of Rudolf I of Habsburg as the new King of Germany. Latter succeeded in uniting Otakar\u27s opponentsin whose eyes his rule was illegitimate. As the Bohemian ruler refused to submit to him, a military conflict began between them in 1276. Otakar was defeated and had to leave the former lands of Babenberg and Spanheim dynasties. Two years later, Otakar tried to regain the lost territorieshowever, was unsuccessful and lost his life at the Battle of Dürnkrut on August 26. This marked the end of a period in which a large part of the present-day Slovenian territory was united under a single ruler

Pulmonary hypertension at admission predicts ICU mortality in elderly critically ill with severe COVID-19 pneumonia: retrospective cohort study

Abstract Background Point-of-care ultrasound (POCUS) is a useful diagnostic tool for non-invasive assessment of critically ill patients. Mortality of elderly patients with COVID-19 pneumonia is high and there is still scarcity of definitive predictors. Aim of our study was to assess the prediction value of combined lung and heart POCUS data on mortality of elderly critically ill patients with severe COVID-19 pneumonia. Methods This was a retrospective observational study. Data of patients older than 70 years, with severe COVID-19 pneumonia admitted to mixed 25-bed, level 3, intensive care unit (ICU) was analyzed retrospectively. POCUS was performed at admission; our parameters of interest were pulmonary artery systolic pressure (PASP) and presence of diffuse B-line pattern (B-pattern) on lung ultrasound. Results Between October 2020 and March 2021, 117 patients aged 70 years or more (average age 77 ± 5 years) were included. Average length of ICU stay was 10.7 ± 8.9 days. High-flow oxygenation, non-invasive ventilation and invasive mechanical ventilation were at some point used to support 36/117 (31%), 39/117 (33%) and 75/117 (64%) patients respectively. ICU mortality was 50.9%. ICU stay was shorter in survivors (8.8 ± 8.3 vs 12.6 ± 9.3 days, p = 0.02). PASP was lower in ICU survivors (32.5 ± 9.8 vs. 40.4 ± 14.3 mmHg, p = 0.024). B-pattern was more often detected in non-survivors (35/59 (59%) vs. 19/58 (33%), p = 0.005). PASP and B-pattern at admission, and also mechanical ventilation and development of VAP, were univariate predictors of mortality. PASP at admission was an independent predictor of ICU (OR 1.061, 95%CI 1.003–1.124, p = 0.039) and hospital (OR 1.073, 95%CI 1.003–1.146, p = 0.039) mortality. Conclusions Pulmonary artery systolic pressure at admission is an independent predictor of ICU and hospital mortality of elderly patients with severe COVID-19 pneumonia

SepsEast Registry indicates high mortality associated with COVID-19 caused acute respiratory failure in Central-Eastern European intensive care units

Abstract The coronavirus disease (COVID-19) pandemic caused unprecedented research activity all around the world but publications from Central-Eastern European countries remain scarce. Therefore, our aim was to characterise the features of the pandemic in the intensive care units (ICUs) among members of the SepsEast (Central-Eastern European Sepsis Forum) initiative. We conducted a retrospective, international, multicentre study between March 2020 and February 2021. All adult patients admitted to the ICU with pneumonia caused by COVID-19 were enrolled. Data on baseline and treatment characteristics, organ support and mortality were collected. Eleven centres from six countries provided data from 2139 patients. Patient characteristics were: median 68, [IQR 60–75] years of age; males: 67%; body mass index: 30.1 [27.0–34.7]; and 88% comorbidities. Overall mortality was 55%, which increased from 2020 to 2021 (p = 0.004). The major causes of death were respiratory (37%), cardiovascular (26%) and sepsis with multiorgan failure (21%). 1061 patients received invasive mechanical ventilation (mortality: 66%) without extracorporeal membrane oxygenation (n = 54). The rest of the patients received non-invasive ventilation (n = 129), high flow nasal oxygen (n = 317), conventional oxygen therapy (n = 122), as the highest level of ventilatory support, with mortality of 50%, 39% and 22%, respectively. This is the largest COVID-19 dataset from Central-Eastern European ICUs to date. The high mortality observed especially in those receiving invasive mechanical ventilation renders the need of establishing national–international ICU registries and audits in the region that could provide high quality, transparent data, not only during the pandemic, but also on a regular basis