Chronic patients: persons with diabetes frequent attenders in Croatian family practice

Chronic diseases cause high frequency visits and generate the long-term frequent attenders (FAs). The connection between frequent attendance and specific morbidities in the health care systems in transitional Europe has been underestimated. We investigated whether frequent visits of chronic patients in primary care are related to characteristic of chronic disease (diabetes mellitus) and whether this is influenced by the family practice in the transitional health care. We analyzed the number of visits a day time work for 490 persons with diabetes in the period 1997 to 2000. As the cut-off points between frequent attenders and non frequent attenders (NFAs) we used the value of the third quartile (Q3) of visits determined for the sex and age groups in the parallel study in the whole population. The analysis was performed for 23 variables: demographic characteristics of patients, disease characteristic and variables of physician. Logistic regressions were employed to identify the predictors of FAs/NFAs. 56.9% (in 1997) to 62.4% (in 2000) persons with diabetes were FAs, compared to 22.4% to 24.3% FAs patients in the whole population. Logistic regression analysis significantly differentiated the two group of visits with 68% accuracy. 4 variables are significant predictors for FAs/NFAs: diabetes as the main disease (p = 0.0005), diet-only-treatment (p = 0.0062), treatment by secondary care (p = 0.0116), and if glycated hemoglobin test (HbA1c) is determined (p = 0.0272). Understanding the similarities and differences of FAs/NFAs persons with diabetes may be important in improving the care and management of chronic diseases in family medicine in transitional health care systems

Prescribing antibiotics to preschool children in primary health care in Croatia

The use of antibiotics depends on cultural and socioeconomic factors, physician's characteristics as well as on microbiological considerations. Aim of our study was to asses antibiotic prescription among preschool children in primary health care in Croatia in relation to socioeconomic factors, symptoms and diagnoses, and type of health care provider. Retrospective longitudinal survey was conducted in 7 teaching primary health care offices in the Croatian capital of Zagreb during 2004, among 1700 preschool children. Antibiotics were prescribed to 611 (46%) children. Significantly more antibiotics were prescribed to boys (66.7%, P = 0.024) and to children whose parents had lower educational level. Most frequently antibiotics were prescribed for the symptoms such as fever (32%), cough (32.5%), nasal discharge (12%), and for the diagnoses such as respiratory diseases (J00-J99) (40%), infectious and parasitic diseases (A00-A99) (31%), and diseases of the middle ear and mastoid (H60-H95) (15%). Logistic regression analyses also predicted correlation of antibiotic prescriptions with socioeconomic factors, symptoms and diagnoses and health care of pediatrician. Prescription of antibiotics for preschool children in primary health care in Croatia related to socioeconomic factors, type of health care provider, certain symptoms and diagnosis groups which should be taken into account when assessing and planning primary health care for preschool children

Guillain-Barre Syndrome in Patients with Seroconversion of IgG Antibodies to Borrelia Burgdorferi sensu lato

A case of polyneuroradiculitis (Guillain-Barre Syndrome) is presented, which was diagnosed in a 62 year-old man after progressive weakness in the legs and arms and double vision, preceded by severe pain in the back. Diagnosis was made on the basis of electromioneurography, a specific finding of cerebrospinal fluid (albumino-citological dissociation), and the clinical course of the disease. Serological analysis of serum included Borellia Burgdorferi sensu lato (BBSL). Positive findings (slowing of conduction velocity of sensor and motor neurones, and marked albumino-citological dissociation), together with the dynamics of these findings on the 33rd, 67th and 101st days and one year and a half after the first clinical signs of disease, indicated the possibility of BBSL infection. Because of the absence of clear clinical and serological signs of other infections it was assumed that BBSL might be the possible trigger for Guillain-Barre Syndrome. The fact that there were no obvious clinical signs of infection with BBSL, only serological, suggests that in the case of unclear aetiology of Guillain-Barre Syndrome BBSL should not be excluded

Crtica s otvorenja novog stalnog postava Muzeja Cetinske krajine - Sinj

U srpnju 2021. Muzej Cetinske krajine je proslavio 65. godišnjicu osnutka. Ususret ovoj velikoj obljetnici, nakon tri i pol godine obnove, 16. travnja, upriličeno je svečano otvorenje Muzeja Cetinske krajine i predstavljanje novog stalnog postava. Rekonstrukcija, obnova i opremanje zgrade Muzeja s dvorištem realizirane su u okviru integriranog projekta Sinj u sridu – projekt obnove i uređenja jedinstvene kulturne baštine Sinja koji je sufinanciran sredstvima Europskog fonda za regionalni razvoj

Crtica s otvorenja novog stalnog postava Muzeja Cetinske krajine - Sinj

U srpnju 2021. Muzej Cetinske krajine je proslavio 65. godišnjicu osnutka. Ususret ovoj velikoj obljetnici, nakon tri i pol godine obnove, 16. travnja, upriličeno je svečano otvorenje Muzeja Cetinske krajine i predstavljanje novog stalnog postava. Rekonstrukcija, obnova i opremanje zgrade Muzeja s dvorištem realizirane su u okviru integriranog projekta Sinj u sridu – projekt obnove i uređenja jedinstvene kulturne baštine Sinja koji je sufinanciran sredstvima Europskog fonda za regionalni razvoj

Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study

Objective: Postoperative bleeding is still one of the most common complications of cardiac surgery. Antifibrinolytic agents successfully reduce bleeding, but there are controversies concerning adverse effects after their systemic use. By topical application of antifibrinolytic agents in pericardial cavity, most of these effects are avoided. We compared the effects of topically applied aprotinin, tranexamic acid and placebo on postoperative bleeding and transfusion requirements. - - - - - Methods: In this single-center prospective, randomized, double-blind trial, 300 adult cardiac patients were randomized into three groups to receive one million IU of aprotinin (AP group), 2.5g of tranexamic acid (TA group) or placebo (PL group) topically before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. - - - - - Results: Postoperative bleeding within first 12-h period (AP group 433+/-294 [350; 360]ml, TA group 391+/-255 [350; 305]ml, PL group 613+/-505 [525; 348]ml), as well as cumulative blood loss within 24h (AP group 726+/-432 [640; 525]ml, TA group 633+/-343 [545; 335]ml, PL group 903+/-733 [800; 445]ml), showed statistically significant inter-group differences (both p<0.001). Bleeding rates values were significantly higher in placebo group compared to the groups treated with antifibrinolytic agents (AP and TA groups) concerning both variables. Although TA group showed the lowest values, no statistical differences between TA and AP groups were found. Inter-group difference of blood product requirements was not statistically significant. - - - - - Conclusions: Topical use of either tranexamic acid or aprotinin efficiently reduces postoperative bleeding. TA seems to be at least as potent as aprotinin, but potentially safer and with better cost-effectiveness ratio

Clinical pharmacist-led program on medication reconciliation implementation at hospital admission: experience of a single university hospital in Croatia

Aim To evaluate the clinical pharmacist-led medication reconciliation process in clinical practice by quantifying and analyzing unintentional medication discrepancies at hospital admission. Methods An observational prospective study was conducted at the Clinical Department of Internal Medicine, University Hospital Dubrava, during a 1-year period (October 2014 – September 2015) as a part of the implementation of Safe Clinical Practice, Medication Reconciliation of the European Network for Patient Safety and Quality of Care Joint Action (PASQ JA) project. Patients older than 18 years taking at least one regular prescription medication were eligible for inclusion. Discrepancies between pharmacists’ Best Possible Medication History (BPMH) and physicians’ admission orders were detected and communicated directly to the physicians to clarify whether the observed changes in therapy were intentional or unintentional. All discrepancies were discussed by an expert panel and classified according to their potential to cause harm. Results In 411 patients included in the study, 1200 medication discrepancies were identified, with 202 (16.8%) being unintentional. One or more unintentional medication discrepancy was found in 148 (35%) patients. The most frequent type of unintentional medication discrepancy was drug omission (63.9%) followed by an incorrect dose (24.2%). More than half (59.9%) of the identified unintentional medication discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration in the patient. Conclusion Around 60% of medication errors were assessed as having the potential to threaten the patient safety. Clinical pharmacist-led medication reconciliation was shown to be an important tool in detecting medication discrepancies and preventing adverse patient outcomes. This standardized medication reconciliation process may be widely applicable to other health care organizations and clinical settings

Suplementacija s antioksidansima u terapiji Graves-ove bolesti: učinak na ekstracelularne antioksidativne parametre

In this study, the effect of supplementation with a fixed combination of antioxidants (vitamins C and E, beta-carotene and selenium) on concentrations of antioxidative parameters in serum was monitored. Measurements were performed prior to the commencement of therapy and after 30 and 60 days in patients with Graves\u27 disease treated with methimazole. Patients who received extra supplementation with antioxidants (group A, n = 29) attained euthyroidism faster than the patients treated only with methimazole (group B, n = 28). Statistically significant differences were achieved after supplementation with antioxidants for all investigated parameters (uric acid, transferrin, ferritin), except TAS and glucose. Nevertheless, due to the fact that all measured parameters remained within the range of referent values, they may not be proposed as reliable indicators of the level of oxidative stress in Graves\u27 disease.U ovom istraživanju promatran jw učinak suplementacije fiksnom kombinacijom antioksidansa (vitamini C i E, β-karoten i selen) na koncentracije pokazatelja antioksidacijske obrane u serume. Mjerenja su obavljena u bolesnika s Graves-ovom bolešću liječenih metilmazolom (tiamazolom) prije početka terapije, te nakon 30 i 60 dana. Bolesnici, koji su uz metimazol imali i dodatnu terapiju s antioksidansima (skupina A, n=29), postizali su eutireozu brže od bolesnika koji su bili samo na terapiji metimazolom (skupina B, n=28). Koncencentracije svim mjernih parametara (urata, feritina i transferina), (osim koncentracije TAS-a i glukoze), značajno su se razlikovale među skupinama. Unatoč tomu, rezultati ove studije ukazuju na to kako se određivani parametri ne mogu smatrati dovoljno pouzdanim pokazateljima razine oksidacijskog stresa u Graves-ovoj bolesti, radi činjenice da su njihove koncentracije tijekom ispitivanja ostale unutar granica referentnih vrijednosti

Comparison of gastrointestinal stability of isothiocyanates from Tropaeolum Majus L. Altum using in vitro and ex vivo digestion methods

Tropaeolum majus L. is an annual herbaceous plant and a member of the Tropaeolaceae family, which belongs to the Brassicales order. It is an excellent source of flavonoids, carotenoids, phenolic acids, vitamin C, and it is a plant that contains the glucosinolate glucotropaeolin. The major degradation product of glucotropaeolin is benzyl isothiocyanate which is known for its various biological activities. In this study, an essential oil was isolated from the seeds of the Tropaeolum majus L. altum plant by microwave-assisted distillation and analysed using the GC-MS technique. Two compounds were identified, benzyl isothiocyanate as the major one (97.81%), and 2-phenylacetonitrile as a minor one (0.80%). Tropaeolum majus L. altum essential oil and pure benzyl isothiocyanate were then submitted to the two-phase in vitro and ex vivo digestion simulations. The analysis performed by the GC-MS/MS technique showed greater stability of benzyl isothiocyanate from essential oil after in vitro (97.57%), and ex vivo (73.47%) gastric phases of the simulated digestion methods, compared to its stability after in vitro (71.17%) and ex vivo (54.90%) intestinal phases. A similar trend was shown for pure benzyl isothiocyanate

Qualitative Analysis of Dermatoglyphics of the Digito-Palmar Complex in Children with Severe Recessive Perceptively Impaired Hearing

The possible hereditary indicated differences in the ascending family tree was investigated in children with severe recessive perceptively impaired hearing, their parents, and healthy controls, using qualitative analysis of dermatoglyphics of the digito-palmar complex. The c2 test was performed and biological distance was investigated by means according to Hiernaux Dg methods, and presented using Ward’s method for the examined groups. The results show that the healthy control group differs from the groups of boys and girls with impaired hearing and also from their fathers mostly in palmar variables. The mothers were biologically more distant from the examined groups of patients, and more similar to the control group of randomly selected healthy female controls. The results indicate polygenic inheritance of sporadic sensoneurial hearing loss