LIJEČENJE TEŠKE DIJABETIČKE KETOACIDOZE U MLADE OSOBE

We present a case of severe diabetic ketoacidosis in a 19-year-old male with a history of poor compliance to insulin therapy. At arrival to our Emergency Department, the patient was comatose with extreme hyperglycemia, severe diabetic ketoacidosis, lactic acidosis and dehydration. The treatment consisted of intensive fl uid replacement and correction of all metabolic disturbances until complete recovery. In the vast majority of severe diabetic ketoacidosis cases, relatively fast and successful treatment result can be expected if intensive therapy is applied and if ketoacidosis is not triggered by a serious illness. Some essential contemporary guidelines and the importance of individual treatment approach are pointed out in the article. The role of high serum procalcitonin value in diabetic ketoacidosis is discussed.Prikazan je slučaj 19-godišnjeg bolesnika od dijabetesa koji nije redovito primjenjivao inzulin. Bolesnik je doveden na naš objedinjeni hitni prijam u komatoznom stanju, s ekstremnom hiperglikemijom, teškom dijabetičkom ketoacidozom, laktacidozom i dehidracijom. Liječen je intenzivnom nadoknadom volumena i korekcijom svih metaboličkih poremećaja do potpunog oporavka. U velikoj većini slučajeva teških dijabetičkih ketoacidoza može se očekivati relativno brza i uspješna korekcija ako se primijeni intenzivno liječenje i ako ketoacidoza nije potaknuta ozbiljnom bolesti. U članku su navedene neke bitne suvremene smjernice u liječenju i naglašena je važnost individualnog pristupa. Raspravljena je i uloga visoke serumske vrijednosti prokalcitonina u dijabetičkoj ketoacidozi

Treatment of Community-Acquired Pneumonia

Pneumonija je akutna infekcija plućnog parenhima i važan uzrok pobola i smrtnosti diljem svijeta. Pojam izvanbolnička pneumonija, CAP (engl. Community-acquired pneumonia) odnosi se na upalu pluća stečenu izvan bolnice. Kamen temeljac liječenja CAP-a jest empirijska antibiotska terapija koju treba primijeniti što je prije moguće, optimalno u prva četiri do šest sati od postavljanja dijagnoze. Različita su mišljenja i preporuke za empirijsku terapiju CAP-a, a izbor ovisi o težini kliničke slike, komorbiditetima bolesnika, lokalnoj prevalenciji patogena i njihovoj očekivanoj rezistenciji na antibiotike. Sva se veća respiratorna društva slažu da empirijska antibiotska terapija treba biti primarno usmjerena na Streptococcus pneumoniae koji je vodeći uzročnik CAP-a. Ciljano antibiotsko liječenje treba primijeniti nakon mikrobiološke izolacije uzročnika bolesti. Za uspješan ishod CAP-a empirijska antibiotska terapija treba biti popraćena potpornim medicinskim mjerama. U novije se vrijeme istražuju i imunomodulatorni lijekovi čija će se učinkovitost, kao moguće dodatne terapije antibioticima, tek pokazati.Pneumonia is an acute infection of the pulmonary parenchyma and a significant cause of morbidity and mortality worldwide. Community-acquired pneumonia (CAP) refers to pneumonia acquired outside of hospital. The cornerstone of treating CAP is empirical antibiotic therapy to be applied as soon as possible, immediately after the assessment of disease severity and the possible expected causes (within four to six hours of establishing the diagnosis). Recommendations for the introduction of empirical antibiotic therapy for CAP vary, and the choice depends on the severity of clinical presentation, comorbidities of patients, the prevalence of pathogens and their expected resistance to antibiotics. All major respiratory societies agree that empirical antibiotic therapy should be primarily focused on Streptococcus pneumoniae, the leading cause of CAP. The targeted antibiotic therapy should be prescribed after isolating microbial pathogens. For the successful outcome of CAP, empirical antibiotic therapy should be accompanied by supportive medical treatment. The immunomodulatory drugs have recently been investigated, and their efficiency, as well as possible additional antibiotic therapies, are yet to be confirmed in treating community-acquired pneumonia

Have we Made Progress in Treating COPD?

Od daleke 1965. kada je prvi puta dr. William Briscoe upotrijebio izraz kronična opstruktivna plućna bolest (KOPB) pa sve do danas, rasla su i mijenjala se saznanja o KOPB-u, a s njima i liječenje ove kronične i progresivne bolesti. Bronhodilatatori su i dalje osnova liječenja, a primjena kombinirane terapije ili najnovije trojne terapije namijenjena je bolesnicima s više simptoma i čestim egzacerbacijama. Daleko veće promjene je doživio sam terapijski pristup. U prošlosti se odluka o liječenju temeljila na stupnju opstrukcije za razliku od današnjeg pristupa, kada težimo personalizaciji u liječenju KOPB-a. Na raspolaganju nam stoje brojni novi lijekovi u različitim inhalatornim uređajima, čime možemo osigurati bolesniku s KOPB-om najbolji terapijski odabir u inhaleru koji najviše odgovara bolesnikovim potrebama. Osim farmakološkog napretka u liječenju KOPB-a, treba istaknuti i razvoj nefarmakoloških metoda liječenja, prije svega plućne rehabilitacije, kao sastavne i ravnopravne komponente u zbrinjavanju bolesnika s KOPB-om. Međutim, današnje liječenje usmjereno je ponajprije zbrinjavanju bolesnika sa značajnim simptomima bolesti. Nedostaju nam lijekovi koji bi mijenjali sam tijek bolesti, odnosno zaustavili daljnju progresiju bolesti. Ne postoje definirane opcije za rani KOPB. U tijeku su brojna istraživanja različitih lijekova za koje se očekuje da budu učinkovita. Međutim za sada niti jedna od ispitivanih opcija nije dovela do značajnijih pomaka. Koliko god nam se činilo da znamo sve o KOPB-u, još uvijek ne znamo dovoljno da bismo ga izliječili.The knowledge about COPD has grown and changed since 1965 when Dr. W. Briscoe first used the term chronic obstructive pulmonary disease (COPD). At the same time, knowledge about the treatment has grown as well. Bronchodilators are still the first-line therapy for COPD, while combination therapies, especially triple combination therapy, are reserved for more symptomatic patients and patients with frequent exacerbations. The therapeutic approach has undergone far greater changes. In the past, treatment recommendation was based primarily on the level of airflow limitation. The assessment system was refined, and today we have the A, B, C, and D groups that define the pharmacological treatment based on symptoms and exacerbation history only. Numerous new drugs are available for patients in a variety of inhaler devices, allowing us to provide COPD patients with the best therapeutic choice in the inhaler that is best for them. In addition to pharmacological advances in COPD treatment, it is necessary to emphasize the development of non-pharmacological methods, primarily pulmonary rehabilitation. However, the direction of treatment is aimed primarily at caring for patients with significant symptoms. We lack drugs that would change the course of COPD and stop further progression of the disease. In addition, there are no defined options for early COPD. Numerous studies of various drugs are expected to be effective, but none of the options examined led to significant progress so far. As much as we think we know everything about COPD, we still do not know enough to cure it

Risk factors and severity of functional impairment in long COVID: a single-center experience in Croatia

Aim To determine the frequency of common symptoms in long COVID and their effect on the quality of life, and to determine the factors contributing to a more severe long COVID. Methods The study enrolled 266 patients who were either referred to long-COVID outpatient clinic or were inpatients undergoing rehabilitation. The data were collected between December 2020 and May 2021. We evaluated the symptoms experienced during acute and long COVID and comorbidities. Functional status was assessed with Post Covid Functional Status (PCFS). Results The final sample consisted of 261 patients. After acute COVID-19 period (>4 weeks), almost 80% of patients had impaired functional status. Only 21.5% reported no functional impairment (0 on PCFS scale). A higher PCFS score was associated with female sex (P<0.001) and oxygen therapy requirement during acute disease (P=0.001). However, it was not associated with having a pre-existing lung disease (P=0.749). Disease severity did not pose a risk for developing a more severe long COVID. Conclusion Women were at greater risk for developing greater functional impairment in long COVID, although we have no explanation why. Malignant disease and hypertension also presented a risk factor for greater functional impairment. More studies are warranted to determine if patients with certain lung disease are more susceptible to long COVID

Risk factors and severity of functional impairment in long COVID: a single-center experience in Croatia

Aim: To determine the frequency of common symptoms in long COVID and their effect on the quality of life, and to determine the factors contributing to a more severe long COVID. ----- Methods: The study enrolled 266 patients who were either referred to long-COVID outpatient clinic or were inpatients undergoing rehabilitation. The data were collected between December 2020 and May 2021. We evaluated the symptoms experienced during acute and long COVID and comorbidities. Functional status was assessed with Post Covid Functional Status (PCFS). ----- Results: The final sample consisted of 261 patients. After acute COVID-19 period (>4 weeks), almost 80% of patients had impaired functional status. Only 21.5% reported no functional impairment (0 on PCFS scale). A higher PCFS score was associated with female sex (P<0.001) and oxygen therapy requirement during acute disease (P=0.001). However, it was not associated with having a pre-existing lung disease (P=0.749). Disease severity did not pose a risk for developing a more severe long COVID. ----- Conclusion: Women were at greater risk for developing greater functional impairment in long COVID, although we have no explanation why. Malignant disease and hypertension also presented a risk factor for greater functional impairment. More studies are warranted to determine if patients with certain lung disease are more susceptible to long COVID