Nursing Management of Patients with Arterial Hypertension

Arterial hypertension (AH), is one of the most prevalent diseases in the words present a major risk factor for strokes, myocardial infarction, vascular and chronic renal disease. Purposes of this the research was to analyze nurses' knowledge about the nursing management of patients with arterial hypertension at the General Hospital Family Medicine Centers in Peja, to review the literature on nursing management in hypertensive patients, and to provide a series of recommendations that affect the quality of nursing management for patients who are suffering from arterial hypertension. Research is quantitative and analytical in nature. It also has an explanatory nature, relying on current international and domestic literature. The paper is also based on the surveying of 100 nurses. We can conclude that therapy is the patient's responsibility in collaboration with the healthcare provider. Educating about high blood pressure and how to manage it, including medications, diet lifestyle changes, weight control and exercise, setting blood pressure goals and social assistance can help the patient reach the blood pressure under control

Diferencijalna dijagnostika i kliničko značenje pneumobilije ili zraka u portalnoj veni na rendgenskoj snimci abdomena

The purpose of the article is to present the differential diagnostic criteria between pneumobilia (air in the biliary system) and portal vein gas on abdominal x-ray. Differential diagnosis is essential because of its influence on patient management. Two patients are presented, one with pneumobilia and the other with portal vein gas on abdominal x-ray, with review of the relevant literature. Pneumobilia is often iatrogenic and even in cases of cholecystitis it is never a sole indication for emergency surgery. Patients with pneumobilia on abdominal x-ray can always be investigated further. On the other hand, the presence of air in portal vein is in most cases a sign of acute mesenteric ischemia. In adults with abdominal pain indicating intestinal ischemia (pain that is ‘out of proportion’ to clinical abdominal examination findings), it is an indication for emergency exploratory laparotomy. It is vital to act early when intestinal ischemia is suspected.Cilj rada je prikazati diferencijalno-dijagnostičke kriterije između pneumobilije i zraka u portalnom venskom sustavu na rendgenskoj snimci nativnog abdomena. Ti kriteriji su ključni, jer o njima ovisi daljnje postupanje s bolesnikom. Prikazane su dvije bolesnice, jedna s nalazom pneumobilije, a druga s nalazom zraka u portalnoj veni na rendgenskoj snimci nativnog abdomena, te je pretražena literatura. Pneumobilija je često jatrogena i čak u slučajevima kolecistitisa nije isključiva indikacija za hitan kirurški zahvat. Bolesnike kod kojih je nađena pneumobilija na snimci nativnog abdomena se uvijek može uputiti na daljnji dijagnostički postupak. Međutim, prisutnost zraka u portalnoj veni je u većini slučajeva znak mezenterijske ishemije. U odraslih bolesnika koji se žale na bol koja bi mogla odgovarati mezenterijskoj ishemiji (vrlo jaka bol uz mekan trbuh) zrak u portalnoj veni je indikacija za hitnu eksplorativnu laparotomiju. Od vitalne važnosti je djelovati brzo kada se sumnja na mezenterijsku ishemiju

Surgical Treatment of Pathologic Fractures in Patients with Metastatic Tumors

The study presents results in treatment of pathologic fractures of long bones of all patients who underwent surgery in the last 10 years in our hospital. The study cohort comprised 133 consecutive patients divided in two groups who underwent surgery of long bone fractures caused by metastatic tumor or trauma. We used resection, open reduction and plating with bone cement application for pathologic fracture and some cases of femoral shaft fractures were stabilized with intramedullary nailing. Proximal femoral fractures were treated with hip arthroplasty or dynamic hip screw. There were 2 amputations performed: one case of pathologic fracture of tibia and one case of humeral fracture. The present study compares results between two group of patients. We noted: age, gender, fracture site, choice of the surgical procedure, hospital stay, need for analgesia after surgery, postoperative complications, and reached level of physical activity after surgery. The mean survival rate was 8.1 months. Seventeen patients experienced postoperative complications. We also found statistically significant improvement in functional scores (MSTS and TESS) in surgically treated patients with pathologic fractures. There are many different techniques of surgical treatment of pathologic fractures caused by skeletal metastases including arthroplasty or a combination of internal fixation combined with polymethyl methacrylate (PMMA) that provides immediate fixation and stability. The present study showed that surgical treatment of pathologic fractures caused by skeletal metastases in vast majority of cases provides bone healing after pathologic fracture, with signifficant improvement of physical activity and rehabilitation in the investigated group

Aortoduodenalna fistula tri godine nakon aorto-bifemoralne premosnice: prikaz slučaja i pregled literature

Secondary aortoenteric fistulas (SAEF ) are a relatively rare but dangerous complication of aortal reconstructive surgery. We present a patient that underwent aortobifemoral bypass three years before developing the signs of aortoenteric fistula, and we reviewed the literature on the topic. Since the clinical signs are nonspecific, physicians should have a high index of suspicion for SAEF in patients who underwent aortal reconstructive surgery. The most useful diagnostic tools for stable patients are upper gastrointestinal endoscopy and computed tomography scan with contrast that can, in combination with history and clinical signs, enable accurate diagnosis in more than 90% of patients. Unstable patients with suspected aortoenteric fistula should undergo exploratory laparotomy. The treatment of choice is open surgery with graft excision, wide debridement of infected tissue, bowel repair or resection followed by an extra-anatomic bypass or in situ placement of a new graft. Early postoperative mortality remains high, around 30% in most analyses. Currently there are no guidelines for the diagnosis and management of SAEF , so individualized approach is necessary for each patient.Sekundarne aorto-enteralne fistule su rijetka ali opasna komplikacija aortne rekonstruktivne kirurgije. Prikazuje se bolesnik kod kojega su se razvili simptomi aorto-enteralne fistule tri godine nakon ugradnje aorto-bifemoralne premosnice, uz pregled literature. S obzirom na to da su klinički znaci vrlo nespecifični kod ovih bolesnika, važno je rano posumnjati na moguć razvoj sekundarne aorto-enteralne fistule kod bolesnika koji su bili podvrgnuti aortnoj rekonstruktivnoj kirurgiji. Od dijagnostičkih metoda najkorisnije su ezofagogastroduodenoskopija i kompjutorizirana tomografija s kontrastom koji, u kombinaciji s anamnezom i kliničkim znacima, omogućavaju postavljanje dijagnoze u preko 90% bolesnika. U nestabilnih bolesnika kod kojih postoji sumnja na razvoj ovoga stanja indicirana je eksplorativna laparotomija. U liječenju metoda izbora je laparotomija, ekscizija proteze, debrideman upaljenog tkiva, popravak defekta na crijevu ili resekcija zahvaćenog segmenta, te ekstraanatomska premosnica ili postavljanje nove proteze. Poslijeoperacijska smrtnost je oko 30%. Kako zasad nema smjernica za dijagnostiku i liječenje bolesnika sa sekundarnim aorto-enteralnim fistulama nužan je visoko individualizirani pristup za svakog bolesnika

Medical Causes and Emergency Basic Care in the Place of Accidents in Road Traffic

Road traffic accidents in Kosovo and around the world are taking many lives, causing casualties; injuries, disability, health problem, suffering, economic problems, family problems and death. Medical causes of road traffic accidents are caused; acute illnesses. Chronic, drugs, alcohol and fatigue etc. The Integrated Education Network of the first medical staff education and training is legally obliged to provide medical care at the scene of the accident to ensure and improve the quality of emergency medical care for victims of road traffic accident. The main purpose of this retrospective research is to identify the main causes of health problems that affect road traffic accidents, reducing morbidity, disability and mortality by implementing first aid measures at the scene of the accident. The research material was taken from the medical documentation of injured in road traffic accidents at the UCCK Emergency Clinic for the period January - December 2019. The research samples were the only injured in road traffic accidents. In the research 5254 cases of road traffic accidents were investigated, the research is of retrospective type, where the medical causes in causing traffic accidents were identified. According to the January - December 2019 patient numbers, there were 86,690 cases requiring medical assistance and 5254 of them being injured in road traffic accidents or 6.06. Medical causes of traffic accidents, 904 cases or 17.20% with diabetes, 680 cases or 12.94% with hypertension, 160 cases or 3.04% with visual problems and other cases with numbers the smallest of cases. Outbreaks with a non-health problem were 3152 cases or 59.99%. finally; Medical Problems Drugs, alcohol can have a direct impact on causing road traffic accidents to a large extent, which need to be timely intervened. The US Integrated Education Network training and training of first medical staff are legally obliged to provide medical care at the scene of the accident to provide and improve the quality of emergency medical care to victims in the event of a road traffic accident

ETIOLOGY OF PROSTATE CANCER

Za rak prostate može se reći da je jedan od najvažnijih medicinskih problema u muškoj populaciji. U razvoju i progresiji karcinoma prostate bitne su epigenetska regulacija ekspresije gena pomoću promotora metilacije i acetilacije histona, proupalni enzim ciklooksigenaza-2, kao i somatske mutacije različitih gena s različitim biološkim funkcijama.Prostate cancer is now recognized as one of the most important medical problems in male population. Epigenetic regulation of gene expression by promoter methylation and histone acetylation, proinfl ammatory enzyme cyclooxygenase-2 and somatic mutations in a variety of genes with diverse biological functions has been implicated in prostate cancer development and progression

The Gallstone Ileus, a Retrospective Study and Review of the Literature

Introduction: Gallstone ileus (GI) is a rare complication of cholelithiasis and is one of the most irregular forms of all mechanical bowel obstructions. It is, however, a more common cause of non-strangulating mechanical small bowel obstruction, accounting for 1% to 4% of all patients and up to 25% in the elderly. The diagnosis is often delayed since symptoms may be intermittent, and investigations may fail to identify the cause of the obstruction. As a result, gallstone ileus continues to be associated with relatively high rates of morbidity and mortality. The cornerstone of healing is the removal of the stone that represents obstruction. As is the case with cholelithiasis, women are more frequently affected. Material and Methods: This article aims to review the incidence of gallstone ileus in our country in the literature, addressing the pathophysiology, clinical presentation, radiological findings, and treatment options. A literature search was done on gallstone ileus for 2005-2018. Results: The patients in the study presentation were both genders and older. They all came to INP because of abdominal pain and general nausea. All had CRP elevation present. Leukocytosis was present in only 2/3 of patients. AST was elevated in one patient and ALT in 2. All changes in laboratory parameters indicate the instability of marker changes and, consequently, the unreliability of use alone without other diagnostic methods. A CT scan was performed on all three patients, but one still needed to be uploaded to the system at the time of writing. Conclusions: Ileus due to gallstones is a rare disease. It is an uncommon cause of mechanical small bowel obstruction. It is a rare complication of chronic cholecystitis and occurs when a gallstone passes through a fistula between the gallbladder and small bowel before becoming impacted at the ileocecal valve. The use of radiological imaging is invaluable in the diagnosis of gallstone ileus. These authors recommend a low threshold for investigation. There is evidence for using AXR as a quick first-line investigation; however, CT scanning is a powerful and gold-standard tool to diagnose the condition and guide its management.

Challenges with Life-Threatening Injuries in the Room of Reanimation.

Introduction: Patients with life-threatening injuries are a significant concern in the emergency department (ED). These injured people require timely care, as their lives depend on it, and a longer wait can result in organ failure, irreversible damage, and poor survival outcomes. The purpose of this research is the evaluation, epidemiology, management, diagnosis, treatment, systematization, and the results obtained for the injured in life-threatening cases with trauma, reducing morbidity, disability, and mortality while increasing survival. Material and Methods. In this retrospective study, we researched and analyzed the data of patients with critical traumatic injuries in DE treated from January-December 2021 Results. During the study period, we analyzed 75,899 ED patients. Of these, 627 cases, or 0.83%, were severely injured and traumatically admitted as a life-threatening traumatic medical emergency in the resuscitation room. Attacked age were males 507 cases or 80.87% and females 120 cases 19.13% and over 16 were 46 cases or 6.67%. The main problem in the admission of the sick was the injured with disorders of consciousness, shock, cardiac, and respiratory failure, as well as issues at the systemic level. Conclusion. During the study period, we analyzed 75,899 ED patients. Of these, 627 cases, or 0.83%, were severely injured and traumatically admitted as a life-threatening traumatic medical emergency in the resuscitation room. Attacked age were males 507 cases or 80.87% and females 120 cases 19.13% and over 16 were 46 cases or 6.67%. The main problem in the admission of the sick was the injured with disorders of consciousness, shock, cardiac, and respiratory failure, as well as issues at the systemic level. Also, these critically injured require structured and well-organized care in the DE in the resuscitation room, with educated medical staff, nurses, and support staff trained with the mandatory BLS, BTLS, PHTLS, and ATLS courses, implementing and developing the algorithms standardized for structured care of the critically injured. Keywords: DE, traumatic, life-threatening medical emergency, CPR. monitoring, management,