Acta clinica Croatica
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Acta clinica Croatica · Dec 2023
PREDICTORS OF INTRAOPERATIVE HYPERTENSION IN NECK SURGERY: A SINGLE CENTER RETROSPECTIVE STUDY.
Intraoperative hypertension (IOHTA) during neck surgery is undesirable because this type of surgery has a propensity to bleed profoundly even in normotensive anesthesia. The purpose of our study was to detect predictors of IOHTA in patients undergoing neck surgery. This single center retrospective study included 880 adult patients who underwent neck surgery under general anesthesia. ⋯ Statistically significant predictors of IOHTA were age (OR 1.438; 95% CI 1.144-1.808; p=0.002), cardiac arrhythmia (OR 1.702; 95% CI 1.129-2.566; p=0.011), Cormack-Lehane grade (OR 1.407; 95% CI 1.054-1.878; p=0.020), and duration of anesthesia (OR 1.005; 95% CI 1.001-1.008; p=0.005). The risk of IOHTA occurrence was lower in patients with induced hypotension (OR 0.024; 95% CI 0.003-0.185; p=0.000). During neck surgery, special attention is needed in patients of older age, those with cardiac arrhythmia, difficult intubation, and longer anesthesia duration because they are at risk of IOHTA.
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Acta clinica Croatica · Dec 2023
INCREASED SEVERE COVID-19-RELATED FATALITY IN HOSPITALIZED MULTIPLE SCLEROSIS PATIENTS.
The aim of this study was to assess the case fatality ratio (CFR) in persons with multiple sclerosis (PwMS) hospitalized due to severe COVID-19, and to investigate the role of risk factors for fatal outcome in this well-defined cohort. This case series study included all PwMS (N=32) with severe COVID-19, who were hospitalized in the COVID-19 referral center in Belgrade from January 2021 to January 2022. Eight out of these 32 patients died from COVID-19 (CFR 25%). ⋯ Multivariate logistic regression analysis showed that progressive forms of MS (p=0.044) and longer hospitalization (p=0.006) significantly increased the risk of death in our MS cohort. In our study, older age, presence of comorbidities, and progressive disease course were independent predictors of increased lethality of COVID-19 in PwMS. More intense monitoring may be warranted in PwMS treated with anti-CD20 agents.
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Acta clinica Croatica · Dec 2023
Case ReportsSHOULD AN ACCESSORY RENAL ARTERY BE CONSIDERED AS A CAUSE OF HYPERTENSION IN ADOLESCENTS: A CASE REPORT.
The role of an accessory renal artery in the pathogenesis of hypertension is still controversial. In this report, we describe a previously healthy 16-year-old girl with an accessory right renal artery who presented with hypertensive urgency (no progressive target organ dysfunction). Initial workup other than hypercholesterolemia and mild proteinuria was normal with no signs of other target organ damage. ⋯ Another diagnostic workup was normal. A satisfactory blood pressure control was eventually achieved with combination therapy including angiotensin-converting enzyme inhibitor. We conclude that although non-stenotic, an accessory renal artery should be considered as a possible cause of renovascular hypertension in children and adolescents even in the absence of hyperreninemia.
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Acta clinica Croatica · Dec 2023
EVALUATION OF THE RELATIONSHIP BETWEEN PARAOXONASE-1 ENZYME ACTIVITY, AFFECTED VOLUME, AND STROKE ONSET IN ACUTE ISCHEMIC STROKE PATIENTS.
Acute ischemic stroke has an important place among emergency department admissions. After a rapid diagnosis of the patient admitted with a preliminary diagnosis of stroke, the necessary examination and first intervention should be performed, then diagnostic evaluation should be made. The aim of this study was to investigate whether paraoxonase-1 (PON-1) enzyme activity, measured in patients whose stroke onset is known, is a diagnostic biomarker for stroke by evaluating the relationship between stroke diagnosis, ischemic area volume, and stroke onset. ⋯ The possible relationship between PON-1 values and stroke onset was compared and no statistically significant difference was found (p=0.311). The relationship between PON-1 enzyme activity and diagnosis of acute ischemic stroke was found to be significant. PON-1 was found to be lower in stroke patients but no correlation was found with ischemic area volume.
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Acta clinica Croatica · Dec 2023
REBLEEDING RATE AND THE NEED OF BLOOD TRANSFUSION ARE HIGHER IN PATIENTS WITH UPPER GASTROINTESTINAL TUMOR BLEEDING THAN IN PATIENTS WITH PEPTIC ULCER BLEEDING.
The aim of our 5-year study (from January 2008 to December 2012) was to compare the incidence of peptic ulcer bleeding (PUB) to bleeding from tumors of the upper gastrointestinal tract. The percentage of re-bleeding within the first 30 days of hospital admission, as well as the need of blood transfusions, are also reported. Statistical data were collected on 2198 patients who were treated in our emergency department due to upper gastrointestinal bleeding (UGIB) in the form of melena or hematemesis. ⋯ The percentage of re-bleeding was lower (9.7% vs. 19.7%, p<0.01) and blood transfusions were less often required (49.5% vs. 75.4%, p<0.01) in PUB. Due to uncontrolled bleeding (5.9% vs. 3.3%, p<0.01), surgical treatment was more often required in cases of PUB, as well as larger volumes of blood transfusion. Patients with PUB had a lower rate of re-bleeding, required surgical intervention more often, and required red blood cell transfusions less frequently.