IMPLEMENTATION OF THE PROGRAM OF PREVENTIVE EXAMINATIONS AT PRIMARY HEALTH CARE IN THE CITY OF ZAGREB 2009-2013

Background: The program covered all persons who had not been in contact with a physician for two years or had failed to notice symptoms themselves or to timely respond to the symptoms observed. The aim of the present study was to analyze the results of the program and try to draw conclusions regarding the necessity further implementation. Subjects and methods: This paper analyzes data on a cohort of 1375 subjects aged 45+, collected on preventive examinations by family physicians during the 2009-2013 period. Results: Results show 24.4% smokers and 15.5% former smokers. Up to three alcoholic drinks per week consumed 18.5% respondents (27.8% male and 11.2% female). Overweight (body mass index 25-30) was recorded in 50.6% and 38.6%, obesity (body mass index >30) in 30.1% and 29.4%, hypertension in 14.6% and 11.8%, isolated systolic hypertension in 20.5% and 17.4%, and isolated diastolic hypertension in 3.3% and 3.0% of male and female subjects, respectively. Suspicion of one or more newly diagnosed disease was recorded in 52.9% (95% CI 50.2-55.5) of study subjects. Fifty-four subjects (7.4%; 95% CI 5.5-9.3) were suspected to have neoplasm and they were immediately referred for further diagnostic evaluation. Conclusions: Timely manner suspicion of malignant disease is of crucial influence on the course of treatment and outcome of the disease. The study results confirm the importance of continuing the implementation of prevention programs

The impact of interventions to improve adherence to preventive measures on the incidence of nosocomial infections in ICUs

Half of all life-threating nosocomial infections occur in intensive care units (ICUs) and, despite the advances in intensive care, the incidence of nosocomial infections is still high. About one third of nosocomial infections are considered preventable. Awareness of risk factors, adherence to preventive measures and collaboration of all members participating in preventive programmes can lead to reduction of the incidence of nosocomial infections and thus can produce a positive impact on reducing morbidity, mortality and healthcare costs. A retrospective surveillance study was performed in a 14-bed medical ICU to identify device-related infections before and after the preventive interventions. Ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) were obtained and compared before and after the interventions. In the year before the interventions, device-related nosocomial infections were diagnosed in 7.9% out of 737 hospitalised patients in the ICU, and in the year after the interventions they were diagnosed in 5.1% out of 684 hospitalised patients. Before the interventions, the infection rates were distributed as follows: 7.5 CLABSI/1000 catheter days, 28.4 VAP/1000 ventilator days, 6.5 CAUTI/1000 catheterisation days. After the interventions, the rates were distributed as follows: 2.5 CLABSI/1000 catheter days, 26.5 VAP/1000 ventilator days and 4.1 CAUTI/1000 catheterisation days. The implementation of effective preventive measures and maintaining strict surveillance is the basis of limiting the risk of nosocomial infections. Since hospital nosocomial infection rate is considered an indicator of quality and safety of care, all infection control activities are focused to decrease rate of nosocomial infections

Amiodaron i tiroidna disfunkcija

Thyroid gland has a key role in maintaining the body homeostasis. Thyroxine is the main hormone secreted from the thyroid gland, its effect being predominantly achieved after the intracellular conversion of thyroxine to triiodothyronine, which exhibits a higher affinity for the receptor complex, thus modifying gene expression of the target cells. Amiodarone is one of the most commonly used antiarrhythmics in the treatment of a broad spectrum of arrhythmias, usually tachyarrhythmias. Amiodarone contains a large proportion of iodine, which is, in addition to the intrinsic effect of the medication, the basis of the impact on thyroid function. It is believed that 15%-20% of patients treated with amiodarone develop some form of thyroid dysfunction. Amiodarone may cause amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT). AIT is usually developed in the areas with too low uptake of iodine, while AIH is developed in the areas where there is a sufficient iodine uptake. Type 1 AIT is more common among patients with an underlying thyroid pathology, such as nodular goiter or Graves’ (Basedow’s) disease, while type 2 mostly develops in a previously healthy thyroid. AIH is more common in patients with previously diagnosed Hashimoto’s thyroiditis. Combined types of the diseases have also been described. Patients treated with amiodarone should be monitored regularly, including laboratory testing and clinical examinations, to early detect any deviations in the functioning of the thyroid gland. Supplementary levothyroxine therapy is the basis of AIH treatment. In such cases, amiodarone therapy quite often need not be discontinued. Type 1 AIT is treated with thyrostatic agents, like any other type of thyrotoxicosis. If possible, the underlying amiodarone therapy should be discontinued. In contrast to type 1 AIT, the basic pathophysiological substrate of which is the increased synthesis and release of thyroid hormones, the basis of type 2 AIT is destructive thyroiditis caused by amiodarone, desethylamiodarone as its main metabolite, and an increased iodine uptake. Glucocorticoid therapy is the basis of treatment for this type of disease.Štitna žlijezda zauzima ključno mjesto u održavanju homeostaze cijeloga organizma. Temeljni hormon koji luči je tiroksin, a učinak se dominantno ostvaruje nakon unutarnje konverzije tiroksina u aktivniji oblik, trijodotironin, koji pokazuje veći afinitet za receptorski kompleks te time modificira gensku ekspresiju ciljnih stanica. Amiodaron je jedan od najčešće upotrebljavanih antiaritmika i rabi se u liječenju širokog spektra aritmija, najčešće tahiaritmija. U svom sastavu sadrži velik udio joda, što je, uz intrinzični učinak lijeka, temelj utjecaja na tireoidnu funkciju. Smatra se kako 15%-20% bolesnika liječenih amiodaronom razvija neki oblik tireoidne disfunkcije. Amiodaron može biti uzrokom razvoja amiodaronom izazvane hipotireoze (amiodarone-induced hypothyroidism, AIH) ili amiodaronom izazvane tireotoksikoze (amiodarone-induced thyrotoxicosis, AIT). AIT se češće razvija u područjima sa smanjenim, dok se AIH razvija u područjima s dovoljnim unosom joda. Razlikujemo dva tipa AIT; tip 1 je češći u bolesnika s podležećom tireoidnom patologijom, najčešće nodoznom strumom ili latentnom Gravesovom (Basedowljevom) bolešću, dok se tip 2 najčešće razvija u prethodno zdravoj štitnjači. AIH je znatno češća u bolesnika s otprije poznatim Hashimotovim tireoiditisom. Opisani su i miješani oblici bolesti. Bolesnike liječene amiodaronom potrebno je redovito pratiti, laboratorijski i klinički, kako bi se pravodobno otkrila bilo kakva odstupanja u tireoidnoj funkciji. Temelj liječenja AIH-a je nadomjesna terapija levotiroksinom. Često u tim slučajevima nije potrebno izostavljati amiodaron iz terapije. AIT tipa 1 liječi se tireostaticima, kao i ostale tireotoksikoze. Ako je moguće, preporuča se prekinuti podležeća amiodaronska terapija. Nasuprot AIT tipa 1, temeljni patofiziološki supstrat kojega je povećana sinteza i otpuštanje tireoidnih hormona, u AIT tipu 2 osnova je destruktivni tireoiditis uzrokovan amiodaronom, dezetilamiodaronom kao njegovim glavnim metabolitom i povećanim unosom joda. Osnova liječenja tog tipa bolesti je glukokortikoidna terapija

VASCULAR VIBRATION INJURY AND PAGET-SHROETTER SYNDROME

Sindrom Paget-Schroetter je relativno rijetko medicinsko stanje koje označava primarnu trombozu aksilarne vene odnosno vene supklavije na kostoklavikularnom spoju. Vibracijska ozljeda rijedak je etiološki čimbenik u nastanku ovog kliničkog entiteta. Prikazujemo slučaj 28-godišnjeg muškarca koji se prezentirao s akutno nastalim edemom lijeve ruke nakon cjelodnevnog rada s pneumatskom bušilicom. Vaskularnim ultrazvukom dokazan je tromb u lijevoj aksilarnoj veni te u veni supklaviji, te je započeta terapija niskomolekularnim heparinom.Paget-Schroetter syndrome is a relatively uncommon condition related to primary thrombosis of the axillary/subclavian vein at the costoclavicular junction. Vibration injury is an unusual cause of this syndrome. We report on a 28-year-old man who presented with acute onset left arm swelling after whole-day work with a pneumatic drill. Duplex ultrasound confirmed the presence of a thrombus in his left axillary and subclavian vein, which was treated with low molecular weight heparin, eventually switched to oral anticoagulation

Chronic Critical Patient: A challenge for modern Critical Care Medicine

Introduction: Cronic critical patients need long term care and multidiscilinary approach. Aim: To show clinical features of chronic critical illness and possible solutions for long term care. Materials and methods: Electronic searches of literature using words related to critical illness, chronic disease, physiotherapy. Results: Most of critically ill patients need prolonged mechanical ventilation and/or tracheostomy. Agressive intensive care treatment, advanced age and comorbidities are major risk factors for development of chronic critical illness. Chronic critical illness except prolonged mechanical ventilation and/or tracheostomy includes severe complications in almost all organs and organ systems (severe neuromyopathy, metabolic disorders, generalized oedema, pressure sores, reccurent infections, hormonal changes, emotional changes, etc.). Prolonged specialized care is associated with high costs for medical equipment and consumable medical supplies. Also, prolonged critical care is a burden for their families due to economic and emotional issues. Conclusion: Chronic critical illness becomes a real problem in the all developed world including Croatia. Multidisciplinary approach is a cornerstone of the care for the chronic critical ill patient and respiratory physiotherapist should be a team leader in that team. Regular early physiotherapy can improve fi nal outcome and decrease the number of complications. National service for prolonged critical care treatment out of acute hospitals and clear guidelines might improve the care for these patients. Long term home treatment is the best way of care, so it is very important to involve family members early at the beginning of intensive care treatment, educate and train them for the taking care of sick family member. Ensuring fi nancial, medical and technical support to the family is important also

Stavovi studenata prve godine u odnosu na šestu godinu medicine u Srbiji prema studiju i poslijediplomskoj karijeri

Self-perceived stress during undergraduate medical training could influence forthcoming career choices. The aim of this study was to explore the attitudes and potential differences between 1st and 6th year students regarding aspects of medical training and career plans. As many as 570 students in 1st and 400 in 6th year of studies at the Faculty of Medicine, University of Belgrade, were recruited on December 2-9, 2013. Data were acquired through a self-administered questionnaire. Students in both years rated “Helping other people” as the most important reason to study medicine. Freshmen rated statistically significantly higher ‘good incomes’ and ‘social status’ as reasons to study medicine (p=0.003 and p=0.037, respectively). The most desirable fields of specialization were surgery and internal medicine (36.4% and 18.7% for 1st year, and 26.3% and 36.6% for 6th year, respectively). Significantly more freshmen would prefer working abroad (χ2=3.891, p=0.029). In terms of careers abroad, students in both years expressed the highest interest in working in western and northern Europe. Desires for specialty training among medical students follow the pattern of the most frequent disciplines in the Serbian physician population, with gender differences comparable to other populations. A certain percentage of students would likely emigrate.Stres tijekom studija medicine mogao bi utjecati na predstojeće izbore u karijeri. Svrha ovog rada bila je istražiti stavove i potencijalne razlike između studenata prve i šeste godine medicine u vezi studija i daljnjih planova u karijeri. Ukupno 570 studenata prve i 400 studenata šeste godine studija na Medicinskom fakultetu Sveučilišta u Beogradu bili su regrutirani za studiju u razdoblju od 2. do 9. prosinca 2013. godine. Podaci su dobiveni putem anonimnog upitnika. Studenti u obje godine ocijenili su “Pomaganje drugim ljudima” kao najvažniji razlog za studij medicine. Brucoši su statistički značajno više ocijenili razloge “dobri prihodi” i “ socijalni status” za studij medicine (p=0,003 odnosno p=0,037). Najpoželjnije specijalizacije bile su kirurgija i interna medicina (36,4% odnosno 18,7% za prvu godinu i 26,3% odnosno 36,6% za šestu godinu). Statistički značajno više brucoša radije bi radili u inozemstvu (χ2=3,891, p=0,029). Studenti koji bi radili u inozemstvu izrazili su najveći interes za rad u zapadnoj i sjevernoj Europi. Želje za specijalizacijom među studentima medicine slijede obrazac najčešćih disciplina među srpskim liječnicima, s rodnim razlikama kakve su prisutne i u drugim populacijama. Određeni postotak studenata vjerojatno će emigrirati

EU project for training in ICU during the COVID pandemic (C19-SPACE)

Pandemija COVID-19 započela je u Wuhanu, Kina, u prosincu 2019. godine, brzo se šireći izvan Kine. U ožujku 2020. godine Svjetska zdravstvena organizacija (SZO) službeno je proglasila pandemiju. Pandemija je imala ozbiljne zdravstvene, socijalne i ekonomske posljedice, a zdravstveni sustav u Hrvatskoj, kao i u većini zemalja svijeta, suočavao se s brojnim izazovima i opterećenjima. Nedostatak bolničkih kreveta, posebno u jedinicama intenzivne medicine (JIM), te manjak medicinskog osoblja s kompetencijama potrebnim za skrb o najtežim bolesnicima predstavljali su ozbiljne izazove i stvarali značajne poteškoće u skrbi oboljelih od bolesti COVID-19. Europsko društvo za intenzivnu medicinu (engl. European Society of Intensive Care Medicine, ESICM) jedno je od prvih društava koje je naglasilo važnost dodatne edukacije liječnika i sestara/tehničara te organiziralo edukaciju za medicinsko osoblje kako bi im pružili osnovna znanja i vještine za rad s bolesnicima zaraženima bolešću COVID- 19. U razdoblju od 10. listopada 2020. do 9. svibnja 2021. provedena je izobrazba prvenstveno neintenzivnog medicinskog osoblja kako bi se povećao broj zdravstvenog osoblja koje bi se moglo rasporediti u vrijeme kada postoji potreba za brzim, privremenim i značajnim povećanjem kapaciteta u JIM-u te unaprijedila kvaliteta zbrinjavanja oboljelih od bolesti COVID-19.The COVID-19 pandemic began in Wuhan, China, in December 2019, quickly spreading out of China. In March 2020, the World Health Organization (WHO) declared the novel coronavirus outbreak a global pandemic. The pandemic had serious health, social, and economic consequences, and healthcare systems in Croatia and most countries worldwide faced numerous challenges and burdens. Shortages of hospital beds, especially in intensive care units (ICUs), and a lack of staff with skills or experience in the management of critically ill patients presented serious challenges.The European Society of Intensive Care Medicine (ESICM) was one of the first organizations to emphasize the importance of additional education for doctors, nurses, and technicians. They organized training for healthcare personnel to provide essential knowledge and skills for managing COVID-19 patients. From October 10, 2020, to May 9, 2021, education was primarily provided to nonintensive care medical personnel to increase the pool of healthcare workers available for rapid, temporary, and significant capacity expansion in ICUs and to enhance the quality of care for COVID-19 patients

Escherichia coli spheroplasts in a Croatian patient misclassified by two urine sediment analysers as erythrocytes: case report

Introduction: It has already been reported that subinhibitory concentrations of β-lactam antibiotics can cause abnormal changes of bacterial forms, such as spheroplasts. Herein we report a case of Croatian male patient with Escherichia coli spheroplasts present in urine after treatment with tazobactam, on the tenth day of hospitalization. The aim of this report is to emphasize the inability of imaging based automated urine analysers to recognize some relatively uncommon forms of bacterial presentation in urine sediment. Materials and methods: During routine urine analysis, unusual particles were observed in patient urine. Urine sediment was examined by two urine analysers: Atellica 1500 (Siemens, Germany) and Iris iQ200 (Beckman Coulter, USA). Additionally, urine was sent for culture testing to Microbiology department. Results: Both urine analysers didn’t indicate presence of bacteria in urine sediment. Unusual particles observed on the tenth day were classified as erythrocytes by both instruments. Dipstick test showed blood trace and microscopic analysis revealed bacteria in urine. Urine culture was positive for Escherichia coli. Careful examination of urine sediment has confirmed that shapes present in urine were abnormal bacterial forms called spheroplasts. Conclusions: Imaging based automated urine analysers are not able to recognize bacterial spheroplasts in urine sediment misclassifying it as erythrocytes. Microscopic examination remains the gold standard for urines with blood trace or negative blood, in which erythrocytes are reported by urine analyser in urine sediment. Failure to identify and follow up such cases may lead to inaccurate treatment decisions and puts patient safety at risk