Large Chondrosarcoma of the Lumbar Spine – A Rare yet Important Cause of Lower Back Pain

We report a case of a large chondrosarcoma of an L4 vertebral body causing iliac vein thrombosis. The slow-growing tumor eluded definitive diagnosis early in its development since the main symptom it caused was only lower back pain. Five years after onset of the disease, the patient presented with fever, tenderness and swelling in the leg, the tumor was diagnosed and found to be exerting a mass effect causing further pain and compressing the left common iliac vein. Due to inoperability of the tumor, a multidisciplinary surgical approach was used to resect the majority of the tumor as a palliative measure and rid the patient of her symptoms. Due to the chemoresistance and relative radioresistance of these tumors, prompt full surgical resection before the tumor invades vital structures remains the mainstay of successful treatment of chondrosarcoma of the spine

Clinical pharmacist-led program on medication reconciliation implementation at hospital admission: experience of a single university hospital in Croatia

Aim To evaluate the clinical pharmacist-led medication reconciliation process in clinical practice by quantifying and analyzing unintentional medication discrepancies at hospital admission. Methods An observational prospective study was conducted at the Clinical Department of Internal Medicine, University Hospital Dubrava, during a 1-year period (October 2014 – September 2015) as a part of the implementation of Safe Clinical Practice, Medication Reconciliation of the European Network for Patient Safety and Quality of Care Joint Action (PASQ JA) project. Patients older than 18 years taking at least one regular prescription medication were eligible for inclusion. Discrepancies between pharmacists’ Best Possible Medication History (BPMH) and physicians’ admission orders were detected and communicated directly to the physicians to clarify whether the observed changes in therapy were intentional or unintentional. All discrepancies were discussed by an expert panel and classified according to their potential to cause harm. Results In 411 patients included in the study, 1200 medication discrepancies were identified, with 202 (16.8%) being unintentional. One or more unintentional medication discrepancy was found in 148 (35%) patients. The most frequent type of unintentional medication discrepancy was drug omission (63.9%) followed by an incorrect dose (24.2%). More than half (59.9%) of the identified unintentional medication discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration in the patient. Conclusion Around 60% of medication errors were assessed as having the potential to threaten the patient safety. Clinical pharmacist-led medication reconciliation was shown to be an important tool in detecting medication discrepancies and preventing adverse patient outcomes. This standardized medication reconciliation process may be widely applicable to other health care organizations and clinical settings

Koncentracija bakterija i gljivica u zraku objekta kavezno držanih nesilica.

This paper describes the concentrations of airborne bacteria and fungi in a cage housed laying hens facility, during a production year. Levels of airborne bacteria established in the air of the poultry house ranged from 1.02×10 4 CFU/m3 measured in April, to 7.72×10 4 CFU/m3 measured in December. Mean values of the total number of fungi ranged from 0.075×10 4 CFU/m3 measured in September, to 8.56×10 4 CFU/m3 measured in June. Established values of air temperature, relative humidity and air velocity were, generally, in accordance with the technology-predicted ranges. The determined number of bacteria and fungi in the air, as well as the statistically significant impact of microclimate conditions on their number in the air of the cage housed laying hens facility, are in accordance with considerations for standards set for air quality in livestock buildings and the development of reliable systems for monitoring the above factors. The aim is to create production that, besides the economic aspects, must include the protection of animals and people, as well as safety of food and environmenU radu je prikazana koncentracija bakterija i gljivica u zraku objekta kavezno smještenih nesilica tijekom proizvodne godine. Broj bakterija izmjerenih u zraku objekta kretao se od 1,02×10 4 CFU/m3, mjereno u travnju, do 7,72×10 4 CFU/m3, mjereno u prosincu. Srednje vrijednosti ukupnog broja gljivica iznosile su od 0,075×10 4 CFU/m3, izmjerene u rujnu, do 8,56×10 4 CFU/m3, izmjereno u lipnju. Izmjerene vrijednosti temperature zraka, relativne vlažnosti i brzine strujanja zraka bile su većinom u tehnologijom predviđenim rasponima. Utvrđeni broj bakterija i gljivica u zraku, kao i statistički značajan utjecaj mikroklimatskih uvjeta na njihov broj u zraku objekta kavezno držanih nesilica, ukazuju na potrebu za postavljanjem standarda o kakvoći zraka u nastambama za životinje te razvoj pouzdanog sustava za praćenje navedenih čimbenika. Cilj je stvoriti proizvodnju koja, osim zadovoljenja ekonomskih čimbenika, mora sadržavati i zaštitu životinja i ljudi, kao i sigurnost hrane i okoliša

Clinical Pharmacist`s Role in Administering Antimicrobial Medicines

Na području Europske unije godišnje umire 33 110 ljudi od posljedica infekcija uzrokovanih bakterijama rezistentnima na antibiotike. To je posljedica neadekvatne primjene antibiotika, sve češće nestašice lijekova, ali i sporog razvoja novih antibiotika. Očuvanje učinkovitosti antimikrobnih lijekova značajan je javni imperativ, uslijed kojeg se nameće potreba za implementacijom programa za antimikrobno upravljanje pomoću tima za antimikrobno upravljanje (A-tim). Znanstveni dokazi upućuju na to kako je za uspješno provođenje programa za antimikrobno upravljanje, uz odgovornost liječnika, neophodna i odgovornost kliničkog farmaceuta kao stručnjaka iz područja lijekova u bilo kojem okruženju. Klinički farmaceut, kroz multidisciplinarnu suradnju – upotrebom svojih farmakoterapijskih znanja i vještina iz područja infektologije – može značajno doprinijeti smanjenju antimikrobne rezistencije. Nadalje, neophodna je provedba edukacije iz područja programa za antimikrobno upravljanje i u dodiplomskoj nastavi na farmaceutskim fakultetima u cilju efikasnijeg provođenja mjera u borbi protiv AMR u okviru sveučilišnog programa.In European Union 33 110 people die annually as a result of antimicrobial-resistant infections. This is due to an inadequate use of antibiotics, increasingly frequent drug shortages, and slow development of new antibiotics. Preservation of antimicrobial medicines is a significant public imperative imposing a high need for the implementation of antimicrobial medicines administering program by an antimicrobial medicines administering team (A-team). The evidence suggests that for the successful implementation of antimicrobial stewardship program with the responsibility of the physicians, the responsibility of a clinical pharmacist, as a specialist in the field of clinical pharmacy, is also necessary. A clinical pharmacist – through multidisciplinary collaboration, by using his or her pharmacotherapeutic knowledge and skills – significantly contributes to the reduction of antimicrobial resistance. Furthermore, the implementation of education in the field of antimicrobial medicines administering program in postgraduate curriculum at the faculties of pharmacy is necessary in order to have more effective implementation of anti-AMR measures within the university program

Clinical Pharmacist`s Role in Administering Antimicrobial Medicines

Na području Europske unije godišnje umire 33 110 ljudi od posljedica infekcija uzrokovanih bakterijama rezistentnima na antibiotike. To je posljedica neadekvatne primjene antibiotika, sve češće nestašice lijekova, ali i sporog razvoja novih antibiotika. Očuvanje učinkovitosti antimikrobnih lijekova značajan je javni imperativ, uslijed kojeg se nameće potreba za implementacijom programa za antimikrobno upravljanje pomoću tima za antimikrobno upravljanje (A-tim). Znanstveni dokazi upućuju na to kako je za uspješno provođenje programa za antimikrobno upravljanje, uz odgovornost liječnika, neophodna i odgovornost kliničkog farmaceuta kao stručnjaka iz područja lijekova u bilo kojem okruženju. Klinički farmaceut, kroz multidisciplinarnu suradnju – upotrebom svojih farmakoterapijskih znanja i vještina iz područja infektologije – može značajno doprinijeti smanjenju antimikrobne rezistencije. Nadalje, neophodna je provedba edukacije iz područja programa za antimikrobno upravljanje i u dodiplomskoj nastavi na farmaceutskim fakultetima u cilju efikasnijeg provođenja mjera u borbi protiv AMR u okviru sveučilišnog programa.In European Union 33 110 people die annually as a result of antimicrobial-resistant infections. This is due to an inadequate use of antibiotics, increasingly frequent drug shortages, and slow development of new antibiotics. Preservation of antimicrobial medicines is a significant public imperative imposing a high need for the implementation of antimicrobial medicines administering program by an antimicrobial medicines administering team (A-team). The evidence suggests that for the successful implementation of antimicrobial stewardship program with the responsibility of the physicians, the responsibility of a clinical pharmacist, as a specialist in the field of clinical pharmacy, is also necessary. A clinical pharmacist – through multidisciplinary collaboration, by using his or her pharmacotherapeutic knowledge and skills – significantly contributes to the reduction of antimicrobial resistance. Furthermore, the implementation of education in the field of antimicrobial medicines administering program in postgraduate curriculum at the faculties of pharmacy is necessary in order to have more effective implementation of anti-AMR measures within the university program

Impact of pharmacotherapeutic education on medication adherence and adverse outcomes in patients with type 2 diabetes mellitus: a prospective, randomized study

Aim To evaluate the impact of pharmacotherapeutic education on 30-day post-discharge medication adherence and adverse outcomes in patients with type 2 diabetes mellitus (T2DM). Methods The prospective, randomized, single-center study was conducted at the Medical Department of University Hospital Dubrava, Zagreb, between April and June 2018. One hundred and thirty adult patients with T2DM who were discharged to the community were randomly assigned to either the intervention or the control group. Both groups during the hospital stay received the usual diabetes education. The intervention group received additional individual pre-discharge pharmacotherapeutic education about the discharge prescriptions. Medication adherence and occurrence of adverse outcomes (adverse drug reactions, readmission, emergency department visits, and death) were assessed at the follow-up visit, 30 days after discharge.Results The number of adherent patients was significantly higher in the intervention group (57/64 [89.9%] vs 41/61 [67.2%]; χ2 test, P = 0.003]. There was no significant difference between the groups in the number of patients who experienced adverse outcomes (31/64 [48.4%] vs 36/61 [59.0%]; χ2 test, P = 0.236). However, higher frequencies of all adverse outcomes were consistently observed in the control group. Conclusion Pharmacotherapeutic education of patients with T2DM can significantly improve 30-day post-discharge medication adherence, without a significant reduction in adverse clinical outcomes

Primjena smjernica za profilaksu venske tromboembolije u kliničkoj praksi: retrospektivno istraživanje u dvjema hrvatskim bolnicama

The aim of this study was to evaluate the implementation of the 9th edition of the American College of Chest Physicians (ACCP9) guidelines for prevention of venous thromboembolism in nonsurgical patients in clinical practice in one university and one general Croatian hospital. A retrospective study was conducted at Zadar General Hospital from Zadar and Dubrava University Hospital from Zagreb. Medical charts of all patients admitted to Medical Departments in two periods, before and after implementation of the ACCP9 guidelines, were analyzed. The ACCP9 guidelines were made available to all physicians through the hospital electronic information system immediately after the publication. The Hospital Drug Committees promoted implementation of the guidelines during their periodical clinical visits. Overall, 850 patients were included in the study in two periods. There was no statistically significant difference in the number of high-risk patients receiving thromboprophylaxis after the guidelines implementation in either hospital. In both periods, a signifi-cantly higher number of high-risk patients received thromboprophylaxis in Dubrava University Hos-pital in comparison with Zadar General Hospital (31.7% vs. 3.8% and 40.3% vs. 7.3%, respectively; p<0.001). This study revealed insufficient implementation of evidence-based thromboprophylaxis guidelines in clinical practice in two Croatian hospitals.Cilj ovoga retrospektivnog istraživanja bio je procijeniti primjenu 9. izdanja smjernica American College of Chest Physicians (ACCP9) za prevenciju venske tromboembolije u nekirurških bolesnika u kliničkoj i općoj bolnici u Republici Hrvatskoj. Istraživanje je provedeno u Općoj bolnici Zadar i Kliničkoj bolnici Dubrava u Zagrebu. Analizirana je medicin-ska dokumentacija svih bolesnika hospitaliziranih na internističke odjele u razdoblju prije i nakon implementacije smjernica ACCP9. Smjernice su bile dostupne svim liječnicima putem bolničkih informatičkih sustava. Bolnička povjerenstva za lijekove su ­tijekom periodičkih kliničkih vizita promovirala primjenu smjernica u kliničkoj praksi. U razdoblju prije i nakon implementacije smjernica u istraživanje je uključeno ukupno 850 bolesnika. Niti u jednoj bolnici nije bilo statistički značajne razlike u broju visoko rizičnih bolesnika koji su dobili tromboprofilaksu nakon implementacije smjernica. U oba razdoblja je broj ­visoko rizičnih bolesnika koji su dobili tromboprofilaksu bio značajno veći u Kliničkoj bolnici Dubrava u odnosu na Opću bolnicu Zadar (31,7% prema 3,8% i 40,3% prema 7,3%; p<0,001). Rezultati istraživanja ukazuju na nedostatnu implementaciju smjernica za tromboprofilaksu u dvjema hrvatskim bolnicama

The Relationship between Methylenetetrahydro-folate Reductase C677T Gene Polymorphism and Diabetic Nephropathy in Croatian Type 2 Diabetic Patients

Methylenetetrahydrofolate reductase (MTHFR) polymorphism has been shown to be associated with the development of diabetic nephropathy in many ethnic groups. In this study, we examined the correlation between MTHFR C677T poly- morphism and microalbuminuria in patients with diabetes mellitus type 2 in Croatian patients. 85 patients with diabetes mellitus type 2 were recruited. Patients were classified into two groups – with and without diabetic nephropathy ac- cording to urinary albumin excretion rate in urine collected during 24 hours. The C677T genotype was determined by real-time PCR analysis. The genotype frequencies were CC 36,5%, CT 42,3% and TT 21,2% in diabetic patients without nephropathy versus CC 39,4%, CT 45,4% and TT 15,2% in those with nephropathy. There was no statistically significant difference in allele distribution between patients with nephropathy and those without (p=0,788). Our study did not show a correlation between mutations in the MTHFR gene and diabetic nephropathy in Croatian patients. Diabetic nephropathy is influenced by multiple risk factors which can modify the importance of MTHFR polymorphism in its de- velopment

Koncentracija bakterija i gljivica u zraku objekta kavezno držanih nesilica.

This paper describes the concentrations of airborne bacteria and fungi in a cage housed laying hens facility, during a production year. Levels of airborne bacteria established in the air of the poultry house ranged from 1.02×10 4 CFU/m3 measured in April, to 7.72×10 4 CFU/m3 measured in December. Mean values of the total number of fungi ranged from 0.075×10 4 CFU/m3 measured in September, to 8.56×10 4 CFU/m3 measured in June. Established values of air temperature, relative humidity and air velocity were, generally, in accordance with the technology-predicted ranges. The determined number of bacteria and fungi in the air, as well as the statistically significant impact of microclimate conditions on their number in the air of the cage housed laying hens facility, are in accordance with considerations for standards set for air quality in livestock buildings and the development of reliable systems for monitoring the above factors. The aim is to create production that, besides the economic aspects, must include the protection of animals and people, as well as safety of food and environmenU radu je prikazana koncentracija bakterija i gljivica u zraku objekta kavezno smještenih nesilica tijekom proizvodne godine. Broj bakterija izmjerenih u zraku objekta kretao se od 1,02×10 4 CFU/m3, mjereno u travnju, do 7,72×10 4 CFU/m3, mjereno u prosincu. Srednje vrijednosti ukupnog broja gljivica iznosile su od 0,075×10 4 CFU/m3, izmjerene u rujnu, do 8,56×10 4 CFU/m3, izmjereno u lipnju. Izmjerene vrijednosti temperature zraka, relativne vlažnosti i brzine strujanja zraka bile su većinom u tehnologijom predviđenim rasponima. Utvrđeni broj bakterija i gljivica u zraku, kao i statistički značajan utjecaj mikroklimatskih uvjeta na njihov broj u zraku objekta kavezno držanih nesilica, ukazuju na potrebu za postavljanjem standarda o kakvoći zraka u nastambama za životinje te razvoj pouzdanog sustava za praćenje navedenih čimbenika. Cilj je stvoriti proizvodnju koja, osim zadovoljenja ekonomskih čimbenika, mora sadržavati i zaštitu životinja i ljudi, kao i sigurnost hrane i okoliša

The effectiveness of lixisenatide as an add on therapy to basal insulin in diabetic type 2 patients previously treated with different insulin regimes: a multi -center observational study

Introduction: This observational study aimed to assess the effectiveness of lixisenatide as add on therapy to basal insulin in diabetic type 2 patients previously treated with different insulin regimes. Methods: Patients with diabetes type 2, prescribed with lixisenatide and basal insulin were divided in three groups (premixed insulin, basal bolus insulin and basal oral therapy (BOT ). Difference in mean change in HbA1c, body mass index, total insulin doses, fasting blood glucose (FPG) and prandial blood glucose (PPG) were assessed after 3–6 ‑months of follow ‑up. Results: The primary outcomes were assessed in 111 patients. Lixisenatide added to basal insulin, reduced HbA1c and body weight significantly in all three groups of patients (p < 0.001 for all), with the most prominent reduction in the basal bolus group of patients which had the highest baseline HbA1c compared to premix and BOT treat ‑ ment groups. Regarding a difference in total insulin dose the reduction was statistically significant in the basal bolus (p = 0.006) and premix group (p < 0.001). FPG and PPG were also significantly reduced over time in all three groups (p < 0.001 for all). A composite outcome (reduction of HbA1c below 7% (53 mmol/mol) with any weight loss) was achieved in 27% of total patients included in the study, reduction of HbA1c below 7% was observed in 30% of patients, while 90% of patients experienced weight reduction. Conclusion: These results indicate that lixisenatide add on basal insulin treatment (BIT ) can improve glycemic con‑ trol in a population with long ‑standing type 2 diabetes and previously uncontrolled on other insulin therap