Endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUSTBNA): Solitary fibrous tumor of the mediastinum

A solitary fibrous tumor is a rare type of mesenchymal neoplasm with a described incidence of 1 new case in a million people a year. It is slowgrowing tumor that can arise almost anywhere in the body, usually with benign characteristics with little or no symptoms, until it grows big enough to cause symptoms of compression. In this case report we presented a patient with a rare case of a mediastinal solitary fibrous tumor

Recognition and management of systemic toxicity of local anesthetics

Simptomi sistemske toksičnosti lokalnih anestetika (LA) mogu oponašati druga klinička stanja. Ponekad ih je teško razlikovati od epileptičkih napada, hipovolemije ili srčanih bolesti. U ovom članku prikazujemo dvije bolesnice koje su razvile simptome kardiotoksičnosti nakon primjene lokalnih anestetika. Kod prve, vaskularne pacijentice, nakon epiduralne anestezije levobupivakainom došlo je do duboke hipotenzije koja je oponašala anafilaktičku reakciju, ali nije bilo nikakvog odgovora na bolusu primjenu adrenalina. Kod druge pacijentice, liječene na Zavodu za intenzivnu medicinu, došlo je do srčanog zastoja nakon intravenske injekcije lidokaina, koji je bio primijenjen za liječenje aritmije. U oba slučaja intravenska primjena lipidne emulzije pomogla je brzom oporavku pacijenata. Dobar odgovor na primjenjenu lipidnu emulziju pridonio je razlikovanju kardiototoksičnosti od alergijske reakcije i srčane dekompenzacije. Usprkos mogućim komplikacija terapije lipidnom emulzijom, istu treba rano primijeniti kod pojave kardiotoksičnosti LA u operacijskoj dvorani i u Jedinici intenzivnog liječenja. Primjereni hemodinamski monitoring može pomoći u njihovom ranom prepoznavanju i ocjeni uspješnosti primijenjene terapije.Systemic toxicity of local anesthetics (LA) may mimic other comorbid conditions. It may be difficult to differentiate from seizures, hypovolaemia, or heart disease. We present two patients who developed severe cardiotoxicity after LA injection. The first was a vascular patient who had severe hypotension after epidural levobupivacaine mimicking an anaphylactic reaction, which did not respond to repeated epinephrine injections. Another patient experienced cardiac arrest after intravenous lidocaine during arrhythmia treatment in the intensive care unit (ICU). In both cases, the lipid emulsion had a beneficial effect in the treatment of refractory hypotension after LA. The lipid emulsion helped to distinguish cardiotoxicity from an allergic reaction and cardiac decompensation. Despite the possible complications of intralipid therapy, it should be considered early in the treatment of systemic cardiotoxicity of local anesthetics, both in surgical theater and intensive care. Appropriate hemodynamic monitoring can also help in the early detection of cardiotoxic effects of local anesthetic and the evaluation of applied therapies

Innovative Insights into In Vitro Activity of Colloidal Platinum Nanoparticles against ESBL-Producing Strains of Escherichia coli and Klebsiella pneumoniae

Growing morbidity and mortality rates due to increase in the number of infections caused by MDR (multi-drug resistant) microorganisms are becoming some of the foremost global health issues. Thus, the need to search for and find novel approaches to fight AMR (antimicrobial resistance) has become obligatory. This study aimed to determine the antimicrobial properties of commercially purchased colloidal platinum nanoparticles by examining the existence and potency of their antibacterial effects and investigating the mechanisms by means of which they express these activities. Antimicrobial properties were investigated with respect to standard laboratory ATCC (American Type Cell Culture) and clinical extended-spectrum beta-lactamase (ESBL)-producing strains of Escherichia (E.) coli and Klebsiella (K.) pneumoniae. Standard microbiological methods of serial microdilution, modulation of microbial cell death kinetics (“time–kill” assays), and biofilm inhibition were used. Bacterial cell wall damage and ROS (reactive oxygen species) levels were assessed in order to explore the mechanisms of platinum nanoparticles’ antibacterial activities. Platinum nanoparticles showed strong antibacterial effects against all tested bacterial strains, though their antibacterial effects were found to succumb to time kinetics. Antibiofilm activity was modest overall and significantly effective only against E. coli strains. By measuring extracellular DNA/RNA and protein concentrations, induced bacterial cell wall damage could be assumed. The determination of ROS levels induced by platinum nanoparticles revealed their possible implication in antibacterial activity. We conclude that platinum nanoparticles exhibit potent antibacterial effects against standard laboratory and resistant strains of E. coli and K. pneumoniae. Both, cell wall damage and ROS induction could have important role as mechanisms of antibacterial activity, and, require further investigatio

The Požega hospital during the war in Croatia

Požeška Bolnica djelovala je u ratnim uvjetima od sredine kolovoza 1991. godine, a do sada je jedna od vrlo rijetkih u Slavoniji koja nije pretrpjela izravna ratna razaranja. Veliki podrumski prostori omogu­ćili su relativno siguran rad i smještaj oko 150 ležajeva. Tijekom rata zbrinuto je 589 ranjenika s požeške i drugih bojišnica. Većina ranjenika ozlijeđena je eksplozivnim oružjima (50%) što je ijedno od značajki ovoga rata. Na hrvatskim bojišnicama 49 Požežana izgubilo je život, od čega je 10 umrlo nakon prijema u bolnicu, šest u prvom satu po prijemu a četiri u prva tri dana. U većine se ranjenika radilo o politraumi, a najčešće su bili ozlijeđeni udovi (73,9%) potom prsni koš, glavai trbuh. Postupnim gašenjem većine hrvatskih bojnišnica, požeška Bolnica postala je oslonac susjednim općinama, prije svega Slavonskom Brodu i Novoj Gradišci, u zbrinjavanju ranjenika s preostalih posavskih bojišta, kao i oboljelih koji još uvijek ne mogu zdravstvenu zaštitu ostvariti u svojim bolnicama.The Požega Hospital worked in war conditions from the midlle of the August 1991. Up to now, it is one of the very rare hospitals that were not damaged. Spacious cellars enabled relatively secure work and the accomodation of cca 150 beds. During the war 589 wounded from Požega and other battlefields were accepted and treated. Half of the wounded (50%) were injured by explosive weapons and this is one of the characteristics of this war. 49 inhabitants of Požega lost their lives on Croatian battlefields. 10 of them died after they were accepted to the hospital; six of them during the first hour after the receipt and four in first three days. The majority of the wounded were polytraumatic cases. The most often limbs were injured (73,9%), upon that thoracic cage, head and belly. As the war had been diminishing, the hospital in Požega became the foot-hold for the neighbourning communities of Slavonski Brod and Nova Gradiška and others in taking care of the wounded from the rest of battlefields in the Sava valley. The hospital took care on other sick people who were not cured in the hospitals in their towns

Hypoosmolar and hyperosmolar COVID-19 patients are predisposed to dismal clinical outcomes

We aimed to investigate the associations of hypo- and hyperosmolarity at hospital admission with clinical characteristics and outcomes in 5645 consecutive hospitalized COVID-19 patients treated at a tertiary-level institution. Serum osmolarity was calculated as 2x Na (mmol/L) + urea (mmol/L) + glucose (mmol/L), with normal range from 275 to 295 mOsm/L. Median serum osmolarity was 292.9 mOsm/L with 51.8% normoosmolar, 5.3% hypoosmolar and 42.9% hyperosmolar patients present at the time of hospital admission. Hypoosmolarity was driven by hyponatremia, and was associated with the presence of chronic liver disease, liver cirrhosis, active malignancy and epilepsy. Hyperosmolarity was driven by an increase in urea and glucose and was associated with the presence of chronic metabolic and cardiovascular comorbidities. Both hypo- and hyperosmolar patients presented with more severe COVID-19 symptoms, higher inflammatory status, and experienced higher mortality in comparison to normoosmolar patients. In multivariate analysis, hypoosmolarity (adjusted odds ratio (aOR)=1.39, p = 0.024) and hyperosmolarity (aOR = 1.9, p < 0.001) remained significantly associated with higher mortality independently of older age, male sex, higher Charlson Comorbidity Index and more severe COVID-19. Disruptions in serum osmolarity are frequent in COVID-19 patients, may be easy to detect and target therapeutically, and thus potentially moderate associateds poor prognosis

Investigating the role of obstructive pulmonary diseases and eosinophil count at admission on all-cause mortality in SARS-CoV-2 patients

Introduction: The impact of asthma and chronic obstructive pulmonary disease (COPD) in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) infection is not clearly defined. Blood eosinophil count is a standard diagnostic test which, according to the previously published literature, might have a potential prognostic role on mortality in patients with SARS-CoV‑2 infection. Aim: To investigate the potential prognostic value of peripheral blood eosinophil count on all-cause mortality of patients hospitalized with SARS-CoV‑2 infection, as well as to assess the impact of asthma or COPD premorbidity on all-cause mortality. Material and methods: We conducted a retrospective registry-based cohort study. Survival analysis was performed by employing the Cox proportional hazards regression model at 30 days of follow-up. Prognostic value of eosinophil count on all-cause mortality was assessed using receiver-operating characteristic (ROC) curve analysis. Results: A total of 5653 participants were included in the study. Our model did not reveal that pre-existing asthma or COPD is a statistically significant covariate for all-cause mortality but, indicated that higher eosinophil count at admission might have a protective effect (hazard ratio, HR 0.13 (95% confidence interval, CI 0.06-0.27), p = 0.0001). ROC curve analysis indicates cut-off value of 20 cells/mm3 (81% specificity; 30.9% sensitivity). Conclusion: Our results indicate that eosinophil count at hospital admission might have a potential prognostic role for all-cause mortality at 30 days of follow-up; however this was not demonstrated for pre-existing obstructive lung diseases