Temporary and permanent central venous catheter infections

Iako se arteriovenska fistula smatra optimalnim pristupom, uporaba trajnih dijaliznih katetera za hemodijalizu je u stalnom porastu. Komplikacije su moguće prilikom postavljanja katetera, ali i kod postavljenih katetera što prije svega uključuje tromboze i infekcije. Infekcija povezana s centralnim venskim kateterima uključuje infekciju mjesta izlazišta katetera, tunela katetera i sistemsku bakterijemiju. Najveća učestalost infekcija je kod femoralnih katetera, a slijede jugularni i potom subklavijalni. U slučajevima pozitivnih hemokultura iz CVK i periferije potrebno je odmah izvaditi kateter i primijeniti sistemsku antimikrobnu terapiju. Preporuč~uju se svakodnevna procjena funkcije, pravilna njega i higijena dijaliznih katetera.The usage of temporary and permanent dialysis catheters for hemodialysis vascular access has been on continual increase. Complications may occur during catheter insertion as well as in the already inserted catheters, e.g., thrombosis and infections. Catheter infection includes the insertion site infection, infection of the tunnel and systemic bacteriemia. Catheter infections are mostly related to femoral catheters. The extraction of catheters with the administration of systemic antimicrobial agents are mandatory in cases with positive blood cultures isolated from central venous catheters or blood stream. Constant evaluation, proper care and hygiene of dialysis catheters are highly recommended

Temporary and permanent central venous catheter infections

Iako se arteriovenska fistula smatra optimalnim pristupom, uporaba trajnih dijaliznih katetera za hemodijalizu je u stalnom porastu. Komplikacije su moguće prilikom postavljanja katetera, ali i kod postavljenih katetera što prije svega uključuje tromboze i infekcije. Infekcija povezana s centralnim venskim kateterima uključuje infekciju mjesta izlazišta katetera, tunela katetera i sistemsku bakterijemiju. Najveća učestalost infekcija je kod femoralnih katetera, a slijede jugularni i potom subklavijalni. U slučajevima pozitivnih hemokultura iz CVK i periferije potrebno je odmah izvaditi kateter i primijeniti sistemsku antimikrobnu terapiju. Preporuč~uju se svakodnevna procjena funkcije, pravilna njega i higijena dijaliznih katetera.The usage of temporary and permanent dialysis catheters for hemodialysis vascular access has been on continual increase. Complications may occur during catheter insertion as well as in the already inserted catheters, e.g., thrombosis and infections. Catheter infection includes the insertion site infection, infection of the tunnel and systemic bacteriemia. Catheter infections are mostly related to femoral catheters. The extraction of catheters with the administration of systemic antimicrobial agents are mandatory in cases with positive blood cultures isolated from central venous catheters or blood stream. Constant evaluation, proper care and hygiene of dialysis catheters are highly recommended

Krutost velikih arterija u terminalnoj fazi endemske nefropatije [Large-artery stiffness in end-stage Endemic nephropathy]

Cardiovascular (CV) diseases are the most frequent cause of death in patients with end-stage-renal- disease (ESRD). Increased arteries stiffness (AS) was found to be independent risk factor. In general population AS is determined by age and blood pressure (BP). In patients with chronic renal disease (CKD) it is influenced additionaly with derangements in phosphate and calcium homeostasis. Endemic (Balkan) nephropathy (EN) is a chronic tubulointerstitial nephropathy characterized by normal BP values in early stages of CKD and hypertension (HT) appears in advanced CKD stages. Obviously, BP in EN has less impact on AS than in other CKD. The aim of this study was to analyze whether AS is lower in EN patients compared to patients with other ESRD undergoing chronic hemodialysis. In this study, 186 patients were included (90 EN, 96 non-EN) from three dialysis centers in Croatia and Bosnia and Herzegovina. After 25 months, control measurements were taken on 97 survived patients still treated with chronic hemodialysis. The obtained results confirmed the hypothesis that AS is lower in patients with EN. Prevalence of hypertension was lower in EN patients and they required less antihypertensives. Patients with EN had significantly lower serum phosphate levels, calcium x phosphate, and parathormone. All these factors were predictors of AS, but in three models of linear regression EN was the strongest negative predictor for AS. In logistic regression the ratio of AS was statistically significantly higher in patients without EN. The patients with EN were significantly older when they started their dialysis treatment, which indicates the slower progression of CKD. These patients had significantly lower CV mortality after 25 months of follow-up. Endemic nephropathy is an independent predictor of lower AS values. AS develops slower due to later onset of HT in predialytic course, lower BP values and milder HT and better control during dialysis treatment. In addition, they had better control of calcium and phosphates, which consequently causes slower progression of kidney disease and lower CV mortality

Hrvatski časopis za javno zdravstvo Korisnik Korisničko ime Lozinka Zapamti me Veličina znakova Make font size smaller Make font size default Make font size larger Jezik / Language ##plugins.block.languageToggle.selectLabel## Sadržaj časopisa Pretraživanje ##plugins.block.navigation.searchScope## Pregled Po broju časopisa Po autoru Po naslovu Informacije Za čitatelje Za autore Za knjižničare Pomoć Naslovna O časopisu Prijava Registracija Pretraživanje Trenutni broj Arhiva Naslovna > Vol 6, Broj 21, 7. siječnja 2010. > Premužić Povećan unos kuhinjske soli utječe na pojavu karcinoma probavnog sustava

Danas u modernoj medicini i znanosti govorimo o mnogim epidemijama, no nekako što zbog neprepoznavanja medija, a što zbog nas samih, zdravstvenih djelatnika, epidemija kardiovaskularne bolesti (KVB), koja je svakom idućom godinom sve opširnija i posljedično tome teže ju je spriječiti, ostaje slabo prevenirana. Jedan od čimbenika koji djeluju na povećanje epidemije KVB je nepravilna, nezdrava i preobilna prehrana. Poznata je činjenica kako je prehrana vrlo bitan faktor zdravlja, te uz štetnost povećanog unosa masti, šećera i kalorija općenito, vrlo je bitna i štetnost povećanog unosa kuhinjske soli u organizam. Odavno prepoznati javno-zdravstveni problem u svijetu je prekomjeran unos kuhinjske soli te je to navelo znanstvenike na pojačano istraživanje nepoželjnih učinaka soli na ljudski organizam. Shvatilo se koliko je važno smanjiti unos soli u organizam te koliko je važno djelovati preventivno, a ne liječiti posljedice dugogodišnjeg prekomjernog unosa

Smjernice za dijagnosticiranje i liječenje hipertenzije ESH/ESC 2007. - što nam donose novo?

Nove smjernice za dijagnosticiranje i liječenje arterijske hipertenzije ističu važnost ukupnoga kardiovaskularnog rizika u odnosu na arterijski tlak, uvedeni su novi čimbenici u stratifikaciji kardiovaskularnog rizika, novi dijagnostički postupci, kao i postupci za procjenu oštećenja ciljnih organa. Posebna pažnja posvećena je bubrežnoj bolesti čiji se parametri sada preporučuju u rutinskoj primjeni pri procjeni oštećenja ciljnih organa, a kao nova kategorija u stratifi kaciji kardiovaskularnog rizika pojavljuje se metabolički sindrom. Pri liječenju važno je težiti smanjivanju oštećenja ciljnih organa i prevenciji nastanka visokorizičnih stanja, a ne samo prevenciji kardiovaskularnih incidenata. S tim ciljem preporučuje se provođenje nefarmakoloških mjera u svih bolesnika. Ističe se ravnopravnost svih 5 skupina antihipertenziva u započinjanju liječenja, ali i dijabetogeni učinak β-blokatora i diuretika. Naglašena je nevažnost odabira prvog lijeka s obzirom na to da većina hipertoničara treba kombinirano liječenje uz poštovanje prednosti pojedinih lijekova u određenim kliničkim stanjima. Smjernice su zadržale svoj savjetodavni karakter i težnju k individualnom pristupu s ciljem što bolje primjene u svakodnevnoj praksi

Mjerenje arterijskoga tlaka

Postavljanje dijagnoze arterijske hipertenzije (AH) te sve odluke o liječenju temelje se na izmjerenim vrijednostima arterijskoga tlaka (AT). Ordinacijsko mjerenje AT-a baždarenim živinim tlakomjerom i dalje je glavna metoda mjerenja u svakodnevnome kliničkom radu, pri čemu je važno pridržavati se određenih pravila i preporuka. Temeljem novih spoznaja, primarno kronobiologije, sve smo svjesniji ograničenja ove metode mjerenja ponajprije zbog naravi same mjerne varijable. Potpuniju sliku o kretanjima AT-a možemo dobiti s pomoću 24h kontinuiranog mjerenja AT-a (KMAT), a izmjerene srednje vrijednosti ovom metodom najviše odgovaraju stvarnima. Kućno mjerenje AT-a samomjeračima (MATS) ne može potpuno zamijeniti KMAT, ali može biti korisno kao dodatni izvor informacija u dijagnostičkom postupku i odlučivanju o liječenju. Obje metode, KMAT i MATS, pokazale su se boljima u predviđanju postojanja i progresije oštećenja ciljnih organa (OCO) u odnosu na ordinacijsko mjerenje. Kod korištenja KMAT-om i MATS-om vrlo je važno voditi računa o uporabi uređaja koji imaju odobrenje međunarodnih stručnih društava, o čemu se možemo informirati na web-stranici www.dableducational.org. Pravilno kombiniranje više načina mjerenja jedini je ispravan put točnijoj dijagnozi AH, procjeni ukupnoga kardiovaskularnog (KV) rizika te sigurnijoj odluci o odabiru načina liječenja

Obesity and Systolic Blood Pressure in Young Adult Men Born Small for Gestational Age

Individuals born small for gestational age (SGA) are supposed to be at higher risk to develop cardiovascular disorders, and recent report showed that concurrent obesity influences blood pressure (BP) in SGA children. Our aim was to investi- gate the impact of obesity and birth weight on blood pressure values in young adult men born SGA and controls born after normal pregnancy, Normotensive, non-treated adult men were enrolled (N=185; mean age 21.29 ± 0.9 years). Birth para- meters were obtained from medical records and SGA was defined as birth weight (BW) under 10th percentile for gestational age and obesity as BMI >25 kg/m2. According to the presence or absence of obesity and BW the subjects were divided into four groups: (1) non-obese with normal BW (N=50), (2) non-obese SGA (N=67), (3) obese with normal BW (N=40), (4) obese SGA (N=28). BP was measured using Omron M6 and Spacelab 90207 device following the ESH/ESC guidelines. Systolic BP 24-hour BP variability and pulse pressure were significantly higher in SGA subjects than in those with normal , BW (p<0.05). The highest 24-hour and daytime systolic BP values as well as 24-hour pulse pressure were found in the sub- group of obese SGA subjects (p<0.001). Significant differences for the above parameters were observed between obese SGA group and non-obese SGA group (p<0.05). Obese SGA subjects had higher 24-hour and daytime systolic BP values com- pared to obese normal BW group. No difference was found in BP between non-obese SGA and non-obese group with normal BW (p>0.05). In addition to BW and shorter pregnancy duration, obesity concurrently and significantly determines sys- tolic BP in young normotensive men and point to a need for more agressive implementation of healthy lifestyle as early as possible

Mjerenje arterijskoga tlaka

Postavljanje dijagnoze arterijske hipertenzije (AH) te sve odluke o liječenju temelje se na izmjerenim vrijednostima arterijskoga tlaka (AT). Ordinacijsko mjerenje AT-a baždarenim živinim tlakomjerom i dalje je glavna metoda mjerenja u svakodnevnome kliničkom radu, pri čemu je važno pridržavati se određenih pravila i preporuka. Temeljem novih spoznaja, primarno kronobiologije, sve smo svjesniji ograničenja ove metode mjerenja ponajprije zbog naravi same mjerne varijable. Potpuniju sliku o kretanjima AT-a možemo dobiti s pomoću 24h kontinuiranog mjerenja AT-a (KMAT), a izmjerene srednje vrijednosti ovom metodom najviše odgovaraju stvarnima. Kućno mjerenje AT-a samomjeračima (MATS) ne može potpuno zamijeniti KMAT, ali može biti korisno kao dodatni izvor informacija u dijagnostičkom postupku i odlučivanju o liječenju. Obje metode, KMAT i MATS, pokazale su se boljima u predviđanju postojanja i progresije oštećenja ciljnih organa (OCO) u odnosu na ordinacijsko mjerenje. Kod korištenja KMAT-om i MATS-om vrlo je važno voditi računa o uporabi uređaja koji imaju odobrenje međunarodnih stručnih društava, o čemu se možemo informirati na web-stranici www.dableducational.org. Pravilno kombiniranje više načina mjerenja jedini je ispravan put točnijoj dijagnozi AH, procjeni ukupnoga kardiovaskularnog (KV) rizika te sigurnijoj odluci o odabiru načina liječenja

Obesity and systolic blood pressure in young adult men born small for gestational age [Pretilost i arterijski tlak u mladih odraslih muškaraca rođenih nakon intrauterinog zastoja u rastu]

Individuals born small for gestational age (SGA) are supposed to be at higher risk to develop cardiovascular disorders, and recent report showed that concurrent obesity influences blood pressure (BP) in SGA children. Our aim was to investigate the impact of obesity and birth weight on blood pressure values in young adult men born SGA and controls born after normal pregnancy, Normotensive, non-treated adult men were enrolled (N = 185; mean age 21.29 +/- 0.9 years). Birth parameters were obtained from medical records and SGA was defined as birth weight (BW) under 10th percentile for gestational age and obesity as BMI > 25 kg/m2. According to the presence or absence of obesity and BW the subjects were divided into four groups: (1) non-obese with normal BW (N = 50), (2) non-obese SGA (N = 67), (3) obese with normal BW (N = 40), (4) obese SGA (N = 28). BP was measured using Omron M6 and Spacelab 90207 device following the ESH/ESC guidelines. Systolic BP, 24-hour BP variability and pulse pressure were significantly higher in SGA subjects than in those with normal BW (p 0.05). In addition to BW and shorter pregnancy duration, obesity concurrently and significantly determines systolic BP in young normotensive men and point to a need for more aggressive implementation of healthy lifestyle as early as possible

Differences in CVVH vs. CVVHDF in the management of sepsis-induced acute kidney injury in critically ill patients

We hypothesized that patients with sepsis and AKI, especially patients without preserved renal function, and treated with continuous veno-venous hemodiafiltration (CVVHDF), have lower risk for mortality than patients treated with continuous veno-venous hemofiltration (CVVH). Patients were included if they fulfilled the diagnosis of severe sepsis or septic shock, suffered AKI and received continuous renal replacement therapy (CRRT) in intensive care unit. There were 62 patients treated by CVVH and 75 treated by CVVHDF. Mean survival time was longer in CVVHDF group with oliguric/anuric patients than in CVVH group. CVVH, and not classic risk factors, was associated with higher overall mortality in oliguric/anuric patients. In the linear regression model, hourly urine output was the strongest and positive predictor of longer survival. CVVHDF is according to our results a CRRT modality of choice for the treatment and lower mortality of septic patients with AKI where renal function is no longer preserved. CRRT has been associated with improved renal recovery, but it should be started earlier in AKI evolution with still preserved hourly urine output which is the most sensitive and prognostic marker of survival in septic patients with AKI