Acta clinica Croatica
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Acta clinica Croatica · Apr 2023
PROCALCITONIN GUIDED ANTIBIOTIC STEWARDSHIP: A BALKAN EXPERT CONSENSUS STATEMENT.
Sepsis as a consequence of infection is a frequent cause of death among critically ill patients. The most common sites of infection are lover respiratory tract, abdominal, urinary tract and catheter-associated blood stream infections. Early empiric, broad-spectrum therapy in those with severe sepsis and/or shock with the aim of reducing mortality may lead to antibiotic overuse, resistance and increased costs. ⋯ In the protocol, they have included the severity of illness, clinical assessment, and PCT levels. Developing a consensus on the clinical algorithm by eminent experts/specialists in various fields of medicine should enable clinicians to use PCT for initiation of antibiotic therapy and monitoring PCT to stop antibiotics earlier. It is crucial that the PCT-guided algorithm becomes an integral part of institutional stewardship program.
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Acta clinica Croatica · Apr 2023
DO THE GUIDELINES GUIDE THE BELGRADE EMERGENCY MEDICAL SERVICE PHYSICIANS THROUGH THE MANAGEMENT OF ACUTE ST-ELEVATION MYOCARDIAL INFARCTION?
The aim of the study was to assess whether current guidelines for diagnosis and treatment of acute ST-elevation myocardial infarction (STEMI) in daily clinical practice are adequately applied in the Belgrade Emergency Medical Service (EMS). A retrospective research included 2,982 STEMI patients who were cared for by EMS teams. Therapy consisting of morphine, oxygen, nitroglycerin and aspirin (MONA) was applied. ⋯ A rapid increase in the use of dual antiaggregation therapy (MONA and clopidogrel or MONA and ticagrelor) was reported from year to year, as well as a dramatic increase in the use of ticagrelor compared to clopidogrel. The time from receiving the call to the arrival on the scene was 13.72 minutes, and the time from receiving the call to hospital arrival was 52.83 minutes. Our physicians care for STEMI patients in accordance with the current international and local recommendations.
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Acta clinica Croatica · Apr 2023
CHRONIC MULTIMORBIDITY OF LOW BACK PAIN OR OTHER CHRONIC BACK DISORDERS IN THE REPUBLIC OF CROATIA.
The aim was to assess the prevalence of chronic multimorbidity in patients with chronic low back pain or other chronic back disorders (BD). We analyzed data from the population-based cross-sectional European Health Interview Survey (EHIS) performed in the Republic of Croatia 2014-2015 by the Croatian Institute of Public Health. Outcome was the point-prevalence of chronic multimorbidity defined as having ≥2 chronic illnesses out of 14 contained in the EHIS questionnaire, after adjustment for ten sociodemographic, anthropometric and lifestyle confounders. ⋯ All chronic comorbidities except for asthma and liver cirrhosis were significantly more prevalent in participants with BD than in participants without BD. In the population with BD, the participants with multimorbidity had three to four times higher odds for unfavorable self-reported health outcomes than the participants with no comorbid conditions, whereas the existence of only one comorbidity was not significantly associated with a worse outcome compared to the population with no comorbidities. In conclusion, the population suffering from BD has a higher prevalence of chronic multimorbidity than the population without BD and this multimorbidity is associated with unfavorable health outcomes.
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Acta clinica Croatica · Apr 2023
Case ReportsCOMBINED USE OF VIDEOLARYNGOSCOPE AND BONFILS INTUBATION ENDOSCOPE AS RESCUE OPTION FOR DIFFICULT AIRWAY MANAGEMENT: A CASE REPORT.
Difficult airway management poses a great challenge for clinicians, especially if it is unanticipated. Numerous guidelines and a wide array of devices constitute the anesthesiologist's armamentarium for managing the airway. When the use of individual devices fails, the use of combination techniques is advised. ⋯ While the videolaryngoscope provided the space needed for BIE and visual guidance through copious secretions, the BIE served as a stylet for endotracheal tube guidance, leading to successful intubation. Since the technique requires costly equipment, experience in handling it and at least two operators, it is more appropriate as a rescue measure than an elective procedure. Given the potentially disastrous outcomes of failed intubation, mastering advanced airway management techniques remains of vital importance, and the combination technique is one of them.
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Acta clinica Croatica · Apr 2023
ULTRASONOGRAPHIC EVALUATION OF FEMORAL CARTILAGE THICKNESS IN PARTICIPANTS WITH ASYMPTOMATIC HYPERURICEMIA: A CASE-CONTROL STUDY.
The aim was to evaluate the effect, if any, of asymptomatic hyperuricemia on distal femoral cartilage thickness through musculoskeletal ultrasonography. A total of 66 participants were evaluated in this prospective, controlled study, including 33 asymptomatic hyperuricemic patients who presented at our outpatient clinic between January and April 2020, and 33 normouricemic subjects matched for age, gender and body mass index. Participants with systemic diseases affecting uric acid level such as chronic renal failure, psoriasis, gout, etc., participants using drugs that can affect uric acid level, and those with knee complaints were excluded from the study. ⋯ No correlation was noted between uric acid levels and cartilage thickness in all measurement areas in either the asymptomatic hyperuricemic or normouricemic group (p>0.05 all). We think that distal femoral cartilages seem to be thinner in participants with asymptomatic hyperuricemia. Longitudinal studies are needed to determine whether asymptomatic hyperuricemia will lead to knee osteoarthritis in individuals, although we believe that people with asymptomatic hyperuricemia should be informed accordingly in order to prevent development of potential knee osteoarthritis.