ZBRINJAVANJE BOLESNIKA S HIPERTENZIVNOM KRIZOM U IZVANBOLNIČKIM UVJETIMA

Background: Hypertensive urgencies are common conditions treated in out-of-hospital Emergency Medical Service units, whereas treatment of hypertensive emergencies from current guidelines is hospital based. Current guidelines do not cover in detail the management of hypertensive urgencies, let alone their management in out-of-hospital setting. Our main goal was to evaluate adherence to the existing guidelines. Patients and Methods: We analyzed data collected by out-of-hospital Emergency Medical Service unit set up in the Community Health Center in the town of Sveti Ivan Zelina, Croatia. During the one-year period, a total of 2911 patients were treated by Emergency Medical Service unit. Arterial hypertension was the primary diagnosis in 177 (6%) patients, of which 143 patients met the inclusion criteria. We further divided patients into two groups, i.e. hypertensive urgency group (blood pressure >180/120 mm Hg) and control group (systolic blood pressure 180/120 mm Hg) bez oštećenja ciljnih organa i kontrolna skupina (krvni tlak <180/120 mm Hg). Uspoređivane su razlike u primjeni antihipertenzivnih i anksiolitičkih (benzodiazepin) lijekova. Rezultati: U skupini hipertenzivne hitnosti sniženje krvnog tlaka iznosilo je 19,5±7,1 %, a u kontrolnoj skupini 10,1±7 %. Najveće sniženje krvnog tlaka zabilježeno je u bolesnika s hipertenzivnom hitnosti koji su primali kombiniranu antihipertenzivnu terapiju uz dodatak nitrata i benzodiazepina (21,9±5,2 %), 14 % bolesnika. Zaključak: Bolesnike koji se očituju hipertenzivnom hitnosti bez oštećenja ciljnih organa (hipertenzivna urgencija) potrebno je liječiti kombiniranom terapijom u kojoj ima mjesta za dodatnu anksiolitičku terapiju benzodiazepinom. Daljnja istraživanja pokazat će značenje tog zaključka

THE ROLE OF ANXIOLYTICS IN HYPERTENSIVE URGENCY MANAGEMENT

Current guidelines do not cover hypertensive urgency management in out-of-hospital setting. Main goal of this study was to evaluate the value of anxiolytic therapy in hypertensive urgencies. We analyzed data gathered by out-of-hospital unit set up during one year. Arterial hypertension was the primary diagnosis in 178 (6.11%) patients, of whom 144 had hypertensive urgency with mean SBP reduction 19.5±7.2%; control group 10.1±6.9%. Anxiolytic therapy was administered in 60% of patients in hypertensive urgency group, and they had a statistically significant greater SBP reduction (p=0.03) than patients who did not receive anxiolytic therapy. There is a place for anxiolytic therapy in hypertensive urgency management

Meningitis caused by Listeria monocytogenes

Akutni bakterijski meningitis je teška, po život opasna infekcija središnjeg živčanog sustava. Javlja se s incidencijom od 2,6 do 6 slučajeva na 100000 u Europi i SAD-u, dok se u zemljama u razvoju taj broj penje i do deseterostruko većih vrijednosti. U zemljama razvijenog svijeta se incidencija akutnog bakterijskog meningitisa uzrokovanog L.monocytogenes kreće oko 2 slučaja na 1.000.000 te zauzima treće mjesto iza S.pneumoniae i N.meningitidis po učestalosti pojedinog uzročnika. Udio među uzročnicima akutnog bakterijskog meningitisa kreće se između 3 i 16%, te najčešće zahvaća imunkompromitirane i osobe starije od 65 godina. Po kliničkoj slici akutni bakterijski meningitis uzrokovan L.monocytogenes se ne razlikuje značajno u odnosu na one uzrokovane drugim uzročnicima. Kao najčešći simptomi navode se povišena tjelesna temperatura, koja je prisutna u 91-100% slučajeva, kočenje šije u 70% te glavobolja u 67-83%. Biokemijskom analizom CSL-a dobivamo uvid radi li se izgledno o bakterijskom ili virusnom meningitisu te dakako postoje li uopće znakovi upale u samom CSL-u. Metoda mikrobiološke izolacije i identifikacije još uvijek je zlatni standard u dijagnostici bakterijskog meningitisa, iako u slučaju onog uzrokovanog Listerijom uspješnost izolacije je niža u odnosu na ostale najčešće uzročnike. U terapiji vodeću ulogu ima antibiotska terapija i to ampicilinom i gentamicinom, iako postoje oprečna mišljenja glede uporabe gentamicina. Uz antibiotsko liječenje važnu ulogu ima i suportivna terapija i održavanje normalnog intrakranijalnog tlaka. Ukupna smrtnost kreće se između 13 i 28%, a zaostale neurološke sekvele javljaju se u 16-52% slučajeva, s tim da je prognoza bolja kod osoba koje nemaju komorbiditete. L.monocytogenes za razliku od ostalih najčešćih uzročnika akutnog bakterijskog meningitisa može uzrokovati i infekciju moždanog parenhima. Infekcija listerijom se može prezentirati i gastroenteritisom, kao i bakterijemijom bez primarnog žarišta. Važno mjesto ima i infekcija trudnice L.monocytogenes zbog moguće infekcije ploda. Od zaražene novorođenčadi oko 60% se oporavi u potpunosti, četvrtina premine, a ostatak ima zaostale neurološke sekvele. U najnovije vrijeme se proučava uporaba L.monocytogenes u terapiji tumora.Acute bacterial meningitis is a severe, life-threatening infection of the central nervous system. Average incidence is between 2,6 and 6 cases per 100.000, in the developing countries that number increases to ten time higher values. In developed countries the incidence of acute bacterial meningitis caused by L.monocytogenes is roughly 2 cases per 1.000.000 and it is the third most common pathogen after S.pneumoniae and N.meningitidis causing 3-16% cases. Most of the patients with listerial meningitis are either older than 65 years or have impaired immunity. The clinical presentation isn't much different compared to the presentation of meningitis caused by other bacterial pathogens. The most common symptoms are: fever (91-100%), nuchal rigidity (70%) and headache (67-83%). Biochemical analysis of the cerebrospinal fluid is made to differentiate whether the meningitis is caused by a virus or a bacteria. Microbiological isolation and identification is still the golden standard in the diagnostics of bacterial meningitis although isolation is less successful with listerial meningitis. Antibiotic administration is the key-step to achieve a favorable outcome. Ampicilin is the antibiotic of first choice. Gentamicin is usually added but there are some authors that doubt the necessity of gentamicin use. Support of the vital functions as well as containing normal intracranial pressure is obligatory in cases of severe meningitis. Mortality of listerial meningitis is between 13 and 28%, sequelae occur in 16-52% of survivors. Unlike the rest of the most common bacteria causing meningitis L.monocytogenes can infect brain tissue. Listerial infection can present as gastroenteritis and bacteriemia also. L.monocytogenes infections in pregnancy can result in miscarriage, stillbirth or preterm labor and surviving neonates can get infected. 60% of the neonates recover fully, 25% die and the rest has neurological sequelae. In the last two decades L.monocytogenes has been studied as a vector in immunotherapy for a number of malignancies

Meningitis caused by Listeria monocytogenes

Akutni bakterijski meningitis je teška, po život opasna infekcija središnjeg živčanog sustava. Javlja se s incidencijom od 2,6 do 6 slučajeva na 100000 u Europi i SAD-u, dok se u zemljama u razvoju taj broj penje i do deseterostruko većih vrijednosti. U zemljama razvijenog svijeta se incidencija akutnog bakterijskog meningitisa uzrokovanog L.monocytogenes kreće oko 2 slučaja na 1.000.000 te zauzima treće mjesto iza S.pneumoniae i N.meningitidis po učestalosti pojedinog uzročnika. Udio među uzročnicima akutnog bakterijskog meningitisa kreće se između 3 i 16%, te najčešće zahvaća imunkompromitirane i osobe starije od 65 godina. Po kliničkoj slici akutni bakterijski meningitis uzrokovan L.monocytogenes se ne razlikuje značajno u odnosu na one uzrokovane drugim uzročnicima. Kao najčešći simptomi navode se povišena tjelesna temperatura, koja je prisutna u 91-100% slučajeva, kočenje šije u 70% te glavobolja u 67-83%. Biokemijskom analizom CSL-a dobivamo uvid radi li se izgledno o bakterijskom ili virusnom meningitisu te dakako postoje li uopće znakovi upale u samom CSL-u. Metoda mikrobiološke izolacije i identifikacije još uvijek je zlatni standard u dijagnostici bakterijskog meningitisa, iako u slučaju onog uzrokovanog Listerijom uspješnost izolacije je niža u odnosu na ostale najčešće uzročnike. U terapiji vodeću ulogu ima antibiotska terapija i to ampicilinom i gentamicinom, iako postoje oprečna mišljenja glede uporabe gentamicina. Uz antibiotsko liječenje važnu ulogu ima i suportivna terapija i održavanje normalnog intrakranijalnog tlaka. Ukupna smrtnost kreće se između 13 i 28%, a zaostale neurološke sekvele javljaju se u 16-52% slučajeva, s tim da je prognoza bolja kod osoba koje nemaju komorbiditete. L.monocytogenes za razliku od ostalih najčešćih uzročnika akutnog bakterijskog meningitisa može uzrokovati i infekciju moždanog parenhima. Infekcija listerijom se može prezentirati i gastroenteritisom, kao i bakterijemijom bez primarnog žarišta. Važno mjesto ima i infekcija trudnice L.monocytogenes zbog moguće infekcije ploda. Od zaražene novorođenčadi oko 60% se oporavi u potpunosti, četvrtina premine, a ostatak ima zaostale neurološke sekvele. U najnovije vrijeme se proučava uporaba L.monocytogenes u terapiji tumora.Acute bacterial meningitis is a severe, life-threatening infection of the central nervous system. Average incidence is between 2,6 and 6 cases per 100.000, in the developing countries that number increases to ten time higher values. In developed countries the incidence of acute bacterial meningitis caused by L.monocytogenes is roughly 2 cases per 1.000.000 and it is the third most common pathogen after S.pneumoniae and N.meningitidis causing 3-16% cases. Most of the patients with listerial meningitis are either older than 65 years or have impaired immunity. The clinical presentation isn't much different compared to the presentation of meningitis caused by other bacterial pathogens. The most common symptoms are: fever (91-100%), nuchal rigidity (70%) and headache (67-83%). Biochemical analysis of the cerebrospinal fluid is made to differentiate whether the meningitis is caused by a virus or a bacteria. Microbiological isolation and identification is still the golden standard in the diagnostics of bacterial meningitis although isolation is less successful with listerial meningitis. Antibiotic administration is the key-step to achieve a favorable outcome. Ampicilin is the antibiotic of first choice. Gentamicin is usually added but there are some authors that doubt the necessity of gentamicin use. Support of the vital functions as well as containing normal intracranial pressure is obligatory in cases of severe meningitis. Mortality of listerial meningitis is between 13 and 28%, sequelae occur in 16-52% of survivors. Unlike the rest of the most common bacteria causing meningitis L.monocytogenes can infect brain tissue. Listerial infection can present as gastroenteritis and bacteriemia also. L.monocytogenes infections in pregnancy can result in miscarriage, stillbirth or preterm labor and surviving neonates can get infected. 60% of the neonates recover fully, 25% die and the rest has neurological sequelae. In the last two decades L.monocytogenes has been studied as a vector in immunotherapy for a number of malignancies

Meningitis caused by Listeria monocytogenes

Akutni bakterijski meningitis je teška, po život opasna infekcija središnjeg živčanog sustava. Javlja se s incidencijom od 2,6 do 6 slučajeva na 100000 u Europi i SAD-u, dok se u zemljama u razvoju taj broj penje i do deseterostruko većih vrijednosti. U zemljama razvijenog svijeta se incidencija akutnog bakterijskog meningitisa uzrokovanog L.monocytogenes kreće oko 2 slučaja na 1.000.000 te zauzima treće mjesto iza S.pneumoniae i N.meningitidis po učestalosti pojedinog uzročnika. Udio među uzročnicima akutnog bakterijskog meningitisa kreće se između 3 i 16%, te najčešće zahvaća imunkompromitirane i osobe starije od 65 godina. Po kliničkoj slici akutni bakterijski meningitis uzrokovan L.monocytogenes se ne razlikuje značajno u odnosu na one uzrokovane drugim uzročnicima. Kao najčešći simptomi navode se povišena tjelesna temperatura, koja je prisutna u 91-100% slučajeva, kočenje šije u 70% te glavobolja u 67-83%. Biokemijskom analizom CSL-a dobivamo uvid radi li se izgledno o bakterijskom ili virusnom meningitisu te dakako postoje li uopće znakovi upale u samom CSL-u. Metoda mikrobiološke izolacije i identifikacije još uvijek je zlatni standard u dijagnostici bakterijskog meningitisa, iako u slučaju onog uzrokovanog Listerijom uspješnost izolacije je niža u odnosu na ostale najčešće uzročnike. U terapiji vodeću ulogu ima antibiotska terapija i to ampicilinom i gentamicinom, iako postoje oprečna mišljenja glede uporabe gentamicina. Uz antibiotsko liječenje važnu ulogu ima i suportivna terapija i održavanje normalnog intrakranijalnog tlaka. Ukupna smrtnost kreće se između 13 i 28%, a zaostale neurološke sekvele javljaju se u 16-52% slučajeva, s tim da je prognoza bolja kod osoba koje nemaju komorbiditete. L.monocytogenes za razliku od ostalih najčešćih uzročnika akutnog bakterijskog meningitisa može uzrokovati i infekciju moždanog parenhima. Infekcija listerijom se može prezentirati i gastroenteritisom, kao i bakterijemijom bez primarnog žarišta. Važno mjesto ima i infekcija trudnice L.monocytogenes zbog moguće infekcije ploda. Od zaražene novorođenčadi oko 60% se oporavi u potpunosti, četvrtina premine, a ostatak ima zaostale neurološke sekvele. U najnovije vrijeme se proučava uporaba L.monocytogenes u terapiji tumora.Acute bacterial meningitis is a severe, life-threatening infection of the central nervous system. Average incidence is between 2,6 and 6 cases per 100.000, in the developing countries that number increases to ten time higher values. In developed countries the incidence of acute bacterial meningitis caused by L.monocytogenes is roughly 2 cases per 1.000.000 and it is the third most common pathogen after S.pneumoniae and N.meningitidis causing 3-16% cases. Most of the patients with listerial meningitis are either older than 65 years or have impaired immunity. The clinical presentation isn't much different compared to the presentation of meningitis caused by other bacterial pathogens. The most common symptoms are: fever (91-100%), nuchal rigidity (70%) and headache (67-83%). Biochemical analysis of the cerebrospinal fluid is made to differentiate whether the meningitis is caused by a virus or a bacteria. Microbiological isolation and identification is still the golden standard in the diagnostics of bacterial meningitis although isolation is less successful with listerial meningitis. Antibiotic administration is the key-step to achieve a favorable outcome. Ampicilin is the antibiotic of first choice. Gentamicin is usually added but there are some authors that doubt the necessity of gentamicin use. Support of the vital functions as well as containing normal intracranial pressure is obligatory in cases of severe meningitis. Mortality of listerial meningitis is between 13 and 28%, sequelae occur in 16-52% of survivors. Unlike the rest of the most common bacteria causing meningitis L.monocytogenes can infect brain tissue. Listerial infection can present as gastroenteritis and bacteriemia also. L.monocytogenes infections in pregnancy can result in miscarriage, stillbirth or preterm labor and surviving neonates can get infected. 60% of the neonates recover fully, 25% die and the rest has neurological sequelae. In the last two decades L.monocytogenes has been studied as a vector in immunotherapy for a number of malignancies

Prevalence and Prognostic Impact of Deranged Liver Blood Tests in COVID-19: Experience from the Regional COVID-19 Center over the Cohort of 3812 Hospitalized Patients

Background: Derangement of liver blood tests (LBT) is frequent in patients with Coronavirus disease 2019 (COVID-19). We aimed to evaluate (a) the prevalence of deranged LBT as well as their association with (b) clinical severity at admission and (c) 30-day outcomes among the hospitalized patients with COVID-19. ----- Methods: Consecutive patients with COVID-19 hospitalized in the regional referral center over the 12-month period were included. Clinical severity of COVID-19 at hospital admission and 30-day outcomes (need for intensive care, mechanical ventilation, or death) were analyzed. ----- Results: Derangement of LBT occurred in 2854/3812 (74.9%) of patients, most frequently due to elevation of AST (61.6%), GGT (46.1%) and ALT (33.4%). Elevated AST, ALT, GGT and low albumin were associated with more severe disease at admission. However, in multivariate Cox regression analysis, when adjusted for age, sex, obesity and presence of chronic liver disease, only AST remained associated with the risk of dying (HR 1.5081 and 2.1315, for elevations 1–3 × ULN and >3 × ULN, respectively) independently of comorbidity burden and COVID-19 severity at admission. Patients with more severe liver injury more frequently experienced defined adverse outcomes. ----- Conclusions: Deranged LBTs are common among patients hospitalized with COVID-19 and might be used as predictors of adverse clinical outcomes