Antimicrobial Treatment and Prophylaxis of Urinary Tract Infections in Adults

U članku su prikazane najnovije smjernice za antimikrobno liječenje i profi laksu infekcija mokraćnog sustava odraslih usklađene s višegodišnjim kliničkim iskustvom, rezultatima praćenja rezistencije najčešćih uzročnika na antimikrobna sredstva, vodećim svjetskim smjernicama, najnovijom stručno- znanstvenom literaturom te primjedbama kolega liječnika, polaznika brojnih tečajeva trajne edukacije održanih o toj temi unatrag 4 godine.This article describes the latest guidelines for antimicrobial treatment and prophylaxis of urinary tract infections in adults. These guidelines are based on long clinical experience, antimicrobial resistance monitoring results for the most common causative agents, leading global guidelines, recent scientifi c and professional literature, and observations of other physicians who attended numerous courses in this fi eld over the last four years

Etiology of Chronic Prostatitis Syndrome in Patients Treated at the University Hospital for Infectious Diseases »Dr. Fran Mihaljevi}« from 2003 to 2005

A total of 835 patients with symptoms of chronic prostatitis syndrome and no evidence of structural or functional lower genitourinary tract abnormalities were examined in a three year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases »Dr Fran Mihaljevi}« Zagreb, Croatia. Disease etiology was determined in 482 (57.72%) patients. Chlamydia trachomatis was proved to be the causative pathogen in 161 patients, Trichomonas vaginalis in 85, Escherichia coli in 68, Enterococcus in 51, Proteus mirabilis in 20, Klebsiella pneumoniae in 9, Streptococcus agalactiae in 15, Ureaplasma urealyticum in 49 patients with chronic prostatitis. Other patients had mixed infection. In 257 (53.32%) of 482 patients, the inflammatory finding (>10 WBCs/hpf) was found in EPS or VB3. Normal WBCs/hpf (<10) was found in 103 (63.98%) of 161 patients with symptoms of chronic prostatitis in whom C. trachomatis was detected in EPS or VB3, in 50 (58.82%) of 85 patients in whom Trichomonas vaginalis was isolated, and in 23 (46.94%) of 49 patients in whom Ureaplasma urealyticum was isolated

Prevalence of Cardiovascular Risk Factors in the Participants of the Public Health Initiative on the Occasion of the 2014 World Heart Day in Zagreb

U sklopu javnozdravstvene akcije koju je u povodu Svjetskog dana srca 2014. godine organizirala Zaklada Hrvatska kuća srca i Grad Zagreb – Gradski ured za zdravstvo u Poliklinici za prevenciju kardiovaskularnih bolesti i rehabilitaciju u Zagrebu osigurani su preventivni kardiovaskularni pregledi za osobe u dobnoj skupini od 40 do 60 godina, koje do sada nisu bile pregledane s kardiološkog aspekta. Cilj je bio uvidjeti tradicionalne čimbenike rizika za kardiovaskularne bolesti (KVB) u spomenutoj skupini i izvijestiti o rezultatima provedene javnozdravstvene akcije. U svih su ispitanika učinjena antropometrijska mjerenja (tjelesna težina, visina, indeks tjelesne mase), određene su vrijednosti serumskih lipida i glukoze natašte te je snimljen 12-kanalni EKG i izmjeren arterijski tlak. Nakon toga su ih pregledali ili internist ili kardiolog. Rezultati su poražavajući, s obzirom na povišen indeks tjelesne mase (ITM) u 3/4 sudionika, prisutnost arterijske hipertenzije (AH) u oko 45% i hiperlipidemije u 55% sudionika. Također, registrirana je češća prisutnost slabije regulirane AH u muškaraca, a u žena se češće bilježi povišen ITM. Dobiveni rezultati naglašavaju i impliciraju potrebu za češćim javnozdravstvenim akcijama.As part of a public health initiative on the occasion of the 2014 World Heart Day, the Croatian Heart House and the City of Zagreb – the City Health Center at the Institute for Cardiovascular Prevention and Rehabilitation in Zagreb – organized preventive cardiovascular examinations for the persons between the ages of 40 and 60 that had not had a cardiac examination before. The goal of this initiative was to detect the traditional risk factors for cardiovascular diseases in the aforementioned group and to report the results of the conducted public initiative. Anthropometric measurements were conducted on all subjects (body weight, height, body mass index), fasting values of serum lipids and glucose were determined, 12-lead ECG was performed, and blood pressure pressure was measured. Following this, the participants were examined by either an internist or a cardiologist. The results were devastating: increased body mass index (BMI) was noted in 2/3 of the patients, as well as the presence of arterial hypertension (AH) in 45%, and hyperlipidemia in 55% patients. Men showed higher prevalence of unregulated AH, and women showed increased BMI. These results emphasize the problem and demonstrate the need for more frequent public health initiatives

Ortostatska intolerancija: sindrom posturalne ortostatske tahikardije s vazovagalnom sinkopom

A 28-year-old female with a history of situational syncope and a new-onset right sided hemiparesis is described. Tilt-up table test revealed the postural orthostatic tachycardia syndrome followed by vasovagal syncope. Neurological and internal medicine tests showed no particular disorders. The patient underwent autonomic physical training and the tilt-up test performed three months later showed improvement of the autonomic system in terms of lower heart beat rate of the postural orthostatic tachycardia syndrome and longer duration of the test. This case report describes longstanding idiopathic dysautonomia that can be improved by nonpharmacological treatment, while reminding that this medical condition may also be the cause of syncope.Prikazuje se 28-godišnja bolesnica s anamnezom višegodišnje situacijske sinkope i novonastalom desnostranom hemiparezom. Učinjen tilt-up table testom utvrđen je sindrom posturalne ortostatske tahikardije (engl. POTS , postural orthostatic tachycardia syndrome), nakon kojeg je uslijedila vazovagalna sinkopa. Neurološkom i internističkom obradom nije utvrđen eventualan drugi uzrok sinkope. Tijekom slijedeća tri mjeseca bolesnica je u kućnim uvjetima provodila ortostatske vježbe autonomnog sustava, nakon čega je učinjen kontrolni tilt-up table test kojim je objektivizirano poboljšanje statusa autonomnog sustava u smislu nižih vrijednosti frekvencije tahikardije POTS -a i duljeg trajanja testa, odnosno održavanja ortostaze. Ovaj slučaj govori o višegodišnjoj idiopatskoj disautonomiji na koju je moguće utjecati nefarmakološkim metodama te je ujedno i podsjetnik na jedan od mogućih uzroka sinkope

Ortostatska intolerancija: sindrom posturalne ortostatske tahikardije s vazovagalnom sinkopom

A 28-year-old female with a history of situational syncope and a new-onset right sided hemiparesis is described. Tilt-up table test revealed the postural orthostatic tachycardia syndrome followed by vasovagal syncope. Neurological and internal medicine tests showed no particular disorders. The patient underwent autonomic physical training and the tilt-up test performed three months later showed improvement of the autonomic system in terms of lower heart beat rate of the postural orthostatic tachycardia syndrome and longer duration of the test. This case report describes longstanding idiopathic dysautonomia that can be improved by nonpharmacological treatment, while reminding that this medical condition may also be the cause of syncope.Prikazuje se 28-godišnja bolesnica s anamnezom višegodišnje situacijske sinkope i novonastalom desnostranom hemiparezom. Učinjen tilt-up table testom utvrđen je sindrom posturalne ortostatske tahikardije (engl. POTS , postural orthostatic tachycardia syndrome), nakon kojeg je uslijedila vazovagalna sinkopa. Neurološkom i internističkom obradom nije utvrđen eventualan drugi uzrok sinkope. Tijekom slijedeća tri mjeseca bolesnica je u kućnim uvjetima provodila ortostatske vježbe autonomnog sustava, nakon čega je učinjen kontrolni tilt-up table test kojim je objektivizirano poboljšanje statusa autonomnog sustava u smislu nižih vrijednosti frekvencije tahikardije POTS -a i duljeg trajanja testa, odnosno održavanja ortostaze. Ovaj slučaj govori o višegodišnjoj idiopatskoj disautonomiji na koju je moguće utjecati nefarmakološkim metodama te je ujedno i podsjetnik na jedan od mogućih uzroka sinkope

Obostrani endogeni endoftalmitis uzrokovan bakterijom pseudomonas aeruginosa u imunokompetentnog bolesnika s nozokomijalnom urosepsom nakon abdominalnog kirurškog zahvata

Endogenous endophthalmitis is a vision-threatening condition that results from hematogenous spread of infection to the eye, originating from a distant primary focus. It is considered as a rare entity that predominantly occurs in immune-compromised patients. We present a case of a critically ill immune-competent patient who underwent abdominal surgery later followed by nosocomial urosepsis complicated with bilateral Pseudomonas aeruginosa endogenous endophthalmitis that resulted in blindness. This case is clinically important because of the absence of predisposing factors for this kind of eye infection.Endogeni endoftalmitis je akutna komplikacija hematogenog rasapa infekcije iz udaljenog žarišta u oči, što u najvećem broju slučajeva rezultira sljepilom. Bolest je rijetka, a najčešće se javlja u imuno kompromitiranih bolesnika. Prikazujemo imuno kompetentnog bolesnika kod kojega se nakon hitne operacije inkarcerirane ingvinalne hernije razvila nozokomijalna urosepsa komplicirana obostranim endogenim endoftalmitisom uzrokovanim bakterijom Pseudomonas aeruginosa, koji je rezultirao sljepilom. Budući da se radi o bolesniku bez prethodno opisanih predisponirajućih čimbenika za razvoj ove teške bolesti, smatramo ovaj prikaz klinički važnim za rano prepoznavanje i što ranije agresivno liječenje ove teške bolesti

Obostrani endogeni endoftalmitis uzrokovan bakterijom pseudomonas aeruginosa u imunokompetentnog bolesnika s nozokomijalnom urosepsom nakon abdominalnog kirurškog zahvata

Endogenous endophthalmitis is a vision-threatening condition that results from hematogenous spread of infection to the eye, originating from a distant primary focus. It is considered as a rare entity that predominantly occurs in immune-compromised patients. We present a case of a critically ill immune-competent patient who underwent abdominal surgery later followed by nosocomial urosepsis complicated with bilateral Pseudomonas aeruginosa endogenous endophthalmitis that resulted in blindness. This case is clinically important because of the absence of predisposing factors for this kind of eye infection.Endogeni endoftalmitis je akutna komplikacija hematogenog rasapa infekcije iz udaljenog žarišta u oči, što u najvećem broju slučajeva rezultira sljepilom. Bolest je rijetka, a najčešće se javlja u imuno kompromitiranih bolesnika. Prikazujemo imuno kompetentnog bolesnika kod kojega se nakon hitne operacije inkarcerirane ingvinalne hernije razvila nozokomijalna urosepsa komplicirana obostranim endogenim endoftalmitisom uzrokovanim bakterijom Pseudomonas aeruginosa, koji je rezultirao sljepilom. Budući da se radi o bolesniku bez prethodno opisanih predisponirajućih čimbenika za razvoj ove teške bolesti, smatramo ovaj prikaz klinički važnim za rano prepoznavanje i što ranije agresivno liječenje ove teške bolesti

Prevention of Chronic Non-Communicable Diseases: Quo Vadis? A New Example from Zagreb

Središnji događaj obilježavanja Svjetskog dana srca 2015. godine u Republici Hrvatskoj bila je otvorena javnozdravstvena akcija probira vodećih čimbenika kardiovaskularnog rizika u Zagrebu. Osobe s izrazito visokom učestalosti čimbenika rizika uključene su u javnozdravstveni program „Čuvari srca“ u kojemu se procjenjivao kardiovaskularni rizik i izdavane su preporuke za očuvanje zdravlja. Cilj je ovog rada izvijestiti o rezultatima te utvrditi važnost detekcije pojedinih čimbenika rizika u osoba s visokim kardiovaskularnim rizikom. Sudionici su samonicijativno, nakon najava u medijima, pristupili besplatnoj detekciji čimbenika kardiovaskularnog rizika pri javnom okupljanja. Prema nahođenju zainteresiranih osoba zdravstveni su djelatnici određivali indeks tjelesne mase (ITM), mjerili vrijednosti arterijskoga tlaka (AT) te određivali glukozu i ukupni kolesterol iz kapilarne krvi. Prvih 100 sudionika akcije s izrazito visokom učestalosti pojedinih čimbenika rizika dobilo je pozivnicu za detaljnu evaluaciju i procjenu kardiovaskularnog rizika u Poliklinici za prevenciju kardiovaskularnih bolesti i rehabilitaciju u Zagrebu. Zasebno su prikazani rezultati obiju akcija. Otvorenoj javnozdravstvenoj akciji probira čimbenika kardiovaskularnog rizika odazvalo se 308 sudionika, i to 59,7 % žena i 40,3 % muškaraca. Prosječna dob sudionika iznosila je 68,8 ± 13,2 godine. Povišen AT (92,5 %) i povišen ITM (46,5 % prekomjerna tjelesna težina; 25,7 % pretilost) najčešći su čimbenici rizika. Izrazito povišena vrijednost ukupnog kolesterola registrirana je u 11,8 %, a izrazito povišena vrijednost glukoze u kapilarnoj krvi u 4,1 % sudionika. Od 100 pozvanih sudionika za akciju procjene kardiovaskularnog rizika odazvalo se njih 77 %, i to 75,3 % žena i 24,7 % muškaraca. Povišene vrijednosti AT-a imalo je njih 90,9 %, dislipidemiju 85,7 %, povećan opseg struka registriran je u 84,4 % sudionika, a njih 78,9 % imalo je povišen ITM. Dodatno smo analizirali rezultate 30 sudionika s otprije poznatom arterijskom hipertenzijom i dislipidemijom i utvrdili su kod njih prisutni čimbenici rizika povišen ITM (80,0 %), povišen opseg struka (76,7 %), povišene vrijednosti urata (23,3 %), C-reaktivnog proteina (16,7 %), kreatinina (10,0 %) i glukoze u krvi (10,0 %). Zaključno, kod sudionika javnozdravstvene akcije najčešći su čimbenici rizika arterijska hipertenzija i povišen ITM. U sudionika s otprije poznatom arterijskom hipertenzijom i dislipidemijom uočili smo blag pristup kako glede neliječenja tih bolesti, tako i što se tiče korekcije nezdravih životnog navika i suboptimalnog medikamentnog liječenja.The central event of the World Heart Day 2015 in Croatia was an open public-health initiative screening for leading cardiovascular risk factors in the city of Zagreb. Individuals with very high risk factor prevalence were accepted into the “Guardians of the Heart” program that assessed cardiovascular risk and offered advice on health. The goal of this article is to report on these results and demonstrate the significance of detecting specific risk factors in individuals with high cardiovascular risk. After an announcement in the media, participants voluntarily applied for free assessment of cardiovascular risk factors during the public event. For interested citizens, health professionals determined the body-mass index (BMI), measured blood pressure (BP), and determined glucose levels and total cholesterol from capillary blood. The first 100 participants with extremely high prevalence of individual risk factors were invited to further detailed evaluation and cardiovascular risk assessment at the Institute for Cardiovascular Prevention and Rehabilitation in Zagreb. The results of both actions are presented here. The open public-health action was attended by 308 participants, of whom 59.7% were women and 40.3% men. The average age was 68.8±13.2 years of age. Elevated BP (92.5%) and BMI (46.5% overweight, 25.7% obese) were the most common risk factors. Highly elevated total cholesterol levels were registered in 11.8% participants, and highly elevated glucose levels in the capillary blood in 4.1%. Of the 100participants invited to detailed cardiovascular risk assessment, 77% responded, of whom 75.2% were women and 24.7% men. Increased BP levels were found in 90.9% of these respondents; dyslipidemia in 85.7%, increased waist size in 84.4%, and 78.9% had elevated BMI. We performed an additional analysis on the results of 30 participants with existing hypertension and dyslipidemia and found elevated risk factors, including elevated BMI (80.0%), waist size (76.7%), urate levels (23.3%), C-reactive protein (16.7%), creatinine (10.0%), and blood glucose levels (10.0%). The most common risk factors in the participants of this public-health action were arterial hypertension and increased BMI. In participants with existing hypertension and dyslipidemia we noted a dismissive approach to these risk factors, both in the sense of non-treatment

Povezanost ventrikulske tahikardije i endotelne disfunkcije u bolesnika s koronarnom bolešću

The objectives of this study were as follows: 1. to examine whether there is an association between individual markers of endothelial dysfunction (ED) with the occurrence of ventricular tachycardia (VT) as a consequence of coronary heart disease (CHD), 2. to analyze possible differences between ED factors in patients with VT as a consequence of CHD compared to those with CHD but without so far recorded VT, 3. to investigate possible association between changes in the levels of serum markers of ED and the incidence of certain forms of VT in patients with proven CHD. The study included a total of 90 subjects who were grouped into three groups of 30 subjects: 1. with documented VT as a result of proven CHD (VT + STEMI), 2. with proven CHD STEMI, and without recorded VT, 3. the control group without CHD and without VT. Patients with diabetes mellitus, congenital disorders, patients with idiopathic VT or family hypertrophic cardiomyopathy, and patients with malignant and infectious diseases were not included in the study. In all examinees medical history was collected, physical examination performed, laboratory hematology and biochemical tests done including certain soluble markers of ED-with adhesion molecules sICAM-1 and sVCAM-1, selectins sP-selectin and sE-selectin and growth factors VEGF and CRP. ECG was performed in all subjects, ergometry in the control group subjects and in the first two groups of patients coronarography and monitored telemetry during the first 24 hours after coronary artery opening. The results of our research have shown significant differences in certain clinical and laboratory parameters, as well as in markers of endothelial dysfunction between patients with STEMI, VT+STEMI and the control group of patients. Clinical and laboratory parameters: 1. LDL, triglycerides and the total number of leukocytes have been significantly increased in patients with STEMI and VT+STEMI compared to the control group, while, between the two groups no significant difference was recorded; 2. Significantly higher values of cQT and glucose have been recorded in patients with VT2 compared to VT-1 group; 3. Significantly higher number of cigarettes smoked have been recorded in groups with STEMI and VT+STEMI compared to the control group. This parameter was significantly higher also in examinees with VT3 compared to examinees with VT4; 4. It is interesting that examinees from the control group had higher BMI than examinees with STEMI or VT+STEMI. BMI was significantly lower in VT3 group, compared to VT4 group; 5. Values of systolic and diastolic pressure have been significantly lower in patients with VT+STEMI compared to patients with STEMI or the control group. Also, the value of systolic pressure was significantly lower in patients with VT1 compared to VT2 group and in VT4 group compared to VT3 group. Markers of endothelial dysfunction: 1. By analyzing the markers of endothelial dysfunction we have demonstrated statistically significant differences between the levels of sE-selectin, sVCAM-1, VEGF and CRP in all investigated groups; 2. The values of CRP have been significantly higher in the control group compared to the group with STEMI, as well as in the group VT+STEMI, although the difference was not statistically significant; 3. The values of sE-selectin have been significantly lower in the group VT+STEMI compared to the other two examined groups, and significantly lower values have been recorded also in the group with STEMI compared to the control group; 4. Similarly lower levels of VEGF have been recorded in both groups compared to the control group, and statistically significant difference has been recorded between STEMI group and the control group; 5. The levels of sVCAM-1 have been higher in the groups with STEMI and/or VT compared to the control group, and significant difference was recorded between the control group and the group with STEMI; 6. We have demonstrated a sigificant correlation between CRP and sVCAM-1 in patients with VT+STEMI; 7. No differences have been found in tested markers of endothelial dysfunction between different types of STEMI+VT

Etiology of chronic prostatitis syndrome in patients treated at the university hospital for infectious diseases "Dr. Fran Mihaljević" from 2003 to 2005

A total of 835 patients with symptoms of chronic prostatitis syndrome and no evidence of structural or functional lower genitourinary tract abnormalities were examined in a three year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases "Dr. Fran Mihaljevic" Zagreb, Croatia. Disease etiology was determined in 482 (57.72%) patients. Chlamydia trachomatis was proved to be the causative pathogen in 161 patients, Trichomonas vaginalis in 85, Escherichia coli in 68, Enterococcus in 51, Proteus mirabilis in 20, Klebsiella pneumoniae in 9, Streptococcus agalactiae in 15, Ureaplasma urealyticum in 49 patients with chronic prostatitis. Other patients had mixed infection. In 257 (53.32%) of 482 patients, the inflammatory finding (>10 WBCs/hpf) was found in EPS or VB3. Normal WBCs/hpf (<10) was found in 103 (63.98%) of 161 patients with symptoms of chronic prostatitis in whom C. trachomatis was detected in EPS or VB3, in 50 (58.82%) of 85 patients in whom Trichomonas vaginalis was isolated, and in 23 (46.94%) of 49 patients in whom Ureaplasma urealyticum was isolated