Clinical Hospital Center Research Articles

Self-medication and knowledge of pregnant women about the use of medication during pregnancy in the cities of Rijeka and Zadar, Croatia

ObjectivesPregnancy is a sensitive period during which the use of medicines, whether by prescription or self-medication, is a major challenge as it can have a significant impact on the health of the mother and the development of the foetus. It is important that pregnant women are well-informed about potential risks and benefits and seek advice from healthcare professionals before taking any medication, including over-the-counter medications, to ensure the safety and health of themselves and their unborn child. The aim of this study was to analyse the self-medication practices of pregnant women and their knowledge and attitudes toward medicines in the context of pregnancy. This includes analysing the way pregnant women make decisions about self-medication and their awareness of potential risks and benefits.MethodsA cross-sectional study was conducted on a sample of pregnant women from two cities of similar size and status, Zadar and Rijeka, in the period from 1 May 2023 to 1 June 2023 at the Clinical Hospital Centre Rijeka and the General Hospital Zadar.ResultsOf the 128 women interviewed, 56% were taking prescription medication, most frequently in Rijeka, while 69.5% practised self-medication. The most commonly used medications were dietary supplements—75 (44.88%); over-the-counter pain relievers and fever, cough, allergy, cold, and nausea remedies—42 (33.07%); and herbal medicines—8 (6.29%).ConclusionPregnant women need to be better informed about self-medication and the safe use of medication. A total of 94.5% of respondents consider it important to improve educational programmes and access to information about the effects of medication on the health of the foetus and pregnancy outcomes.

A retrospective study on potential drug‒drug interactions in patients with severe asthma receiving biological therapy: a single-center experience

BackgroundPrevalence of potential drug-drug interactions (pDDIs) in adult patients with severe asthma on biological therapy and their clinical significance have not been fully addressed, thus the aim of this study was to investigate them.MethodsIn this retrospective observational study, patients who were diagnosed with severe asthma and to whom biological therapy was prescribed between September 2015 and December 2020, were enrolled. The study was conducted at the Department of Allergic and Obstructive Pulmonary Diseases, Clinic for Lung Diseases Jordanovac, Clinical Hospital Center Zagreb. Data on demographic characteristics as well as concomitant medication were collected. The analysis of pDDIs was conducted via Lexicomp® online software. Interactions of significance levels A and B were only recorded, while those of levels C, D and X were further analysed. The collected data was processed via Microsoft Excel 365 software.Results60 adult patients, 60% female and 40% male, with median age of 56.2 years, were enrolled. The incidence of pDDIs was 86.67%. Total number of pDDIs detected was 518, out of which 43.24%, 45%, 4.44% and 7.3% of clinical significance B, C, D and X. Interactions of level C, D and X were recorded in, as follows: 83.33%, 25% and 33.33% patients with an average of 4.66, 1.53 and 1.9 interactions per patient. Only 13.33% of the patients had none of the potential clinically significant DDI. Most drug pairs contained at least one antiasthmatic drug. Muscarinic receptor antagonists, oral corticosteroids, β2 agonists and methylxanthines showed potential of entering into clinically significant DDIs, while leukotriene antagonists and biologicals showed no potential for the above.ConclusionPrevalence of potential drug-drug interactions in patients with severe asthma on biological therapy is high. The majority of identified interactions have moderate to high level of clinical significance. Their identification, prevention and resolution could contribute to optimizing therapy, maximizing its therapeutic effect and avoiding undesirable adverse events.

Hyperbaric Oxygen Therapy in the Treatment of Crohn's Disease.

Background/Objectives: Our study describes hyperbaric oxygen therapy (HBOT) as an additional therapy in the conservative treatment of Crohn's disease (CD) and its benefit in the early postoperative period to prevent surgical complications and improve gastrointestinal motility. Methods: This retrospective study evaluated HBOT in patients hospitalized at the Clinical Hospital Center Split for complications of CD between 2015 and 2020. Patients (N = 61) aged 19 to 67 with perianal fistulas, abscesses, fistulas, obstruction, stenosis, or bleeding were included, excluding those with ulcerative colitis or requiring intensive care. Patients were retrospectively divided into conservatively and surgically treated groups, and HBOT was administered over 15-25 days, with treatment lasting 60 min at 2.2 absolute atmospheres (ATA). We analyzed treatment outcomes between the HBOT-treated surgical and conservative groups and compared patients treated with HBOT to a cohort from the preceding five years who did not receive HBOT. Results: We treated 61 CD patients with HBOT, including 34 conservatively and 27 surgically treated patients. HBOT significantly reduced disease activity indices (311.7 ± 59.1 vs. 114 ± 29.8; 203.6 ± 24.1 vs. 83.8 ± 15, for conservatively treated patients, and 352.8 ± 45.7 vs. 109 ± 22.8; 270.4 ± 19.7 vs. 140.3 ± 10.6 for surgically treated patients) and accelerated bowel peristalsis recovery, with 94.1% of conservatively treated patients achieving remission. Comparison with a historical cohort showed faster recovery and improved outcomes in the HBOT group. Conclusions: HBOT is useful in postponing or avoiding surgical treatment, and in operated patients, it improves postoperative recovery and reduces the rate of postoperative complications.

Outbreak of hantavirus disease caused by Puumala virus, Croatia, 2021.

In 2021, a large outbreak of hantavirus disease (HAVID) in Croatia with 334 notified cases coincided with a COVID-19 wave and included patients from areas previously not considered endemic, challenging HAVID recognition and patient management. We analysed clinical and epidemiological data on all 254 patients with HAVID treated in the Clinical Hospital Center Rijeka (CHC Rijeka) between February and November 2021. Most patients (n = 246; 96.9%) had antibodies against Puumala virus, 212 (83.5%) were residents of endemic areas for HAVID, 93 (36.6%) reported occupational exposure and 86 (33.9%) had observed rodents or rodent excreta. Thirty-seven (14.6%) patients were not notified to the public health authorities. Most patients (n = 177; 69.7%) were male. The median age of the patients was 43 years (range: 17-79 years) in males and 54 years (range: 14-77 years) in females. More severe courses of disease were observed in males aged < 45 years than in older males and females of any age (OR = 2.27; 95% CI: 1.21-4.24; p < 0.005). Measures to prevent exposure, early detection and notification of cases and close collaboration between primary and secondary healthcare teams with public health personnel are essential to improve surveillance and prevent hantavirus outbreaks.

A PROGNOSTIC MODEL FOR SURGICAL SITE INFECTION

The aim of the study is to determine the incidence of surgical site infection (SSI), risk factors for its development and to evolve a prognostic model for stratifying patients according to its level. Materials and Methods. The study was conducted at Ulyanovsk Regional Clinical Hospital and Ulyanovsk Regional Clinical Oncology Center. A total of 1,500 planned laparotomies were performed (database registration certificate No. 2024623300) including 190 gastrectomies with D2 lymph node dissection, 882 colon resections, and 428 total hysterectomies. A retrospective analysis of the results was carried out during the postoperative period according to a single protocol. StatTech v. 4.5.0 (Stattech, Russia) and SPSS 26 for Mac (IBM Corp.), R Statistics 3.6.1 were used for statistical analysis of the study results. Results. The incidence of SSI was 4.93 % (74/1500). There were 12 fatal outcomes (16.2 %) in the group with SSI and 15 ones (1.1 %) in the group without SSI. The most significant factors influencing the development of postoperative infectious complications in the surgical site are age (p=0.007), diabetes mellitus (p&lt;0.001), subcutaneous fat thickness (p&lt;0.001), neutrophil-to-lymphocyte ratio (p&lt;0.001), body mass index (p&lt;0.001), and surgery duration (p&lt;0.001). Multivariate analysis showed that only the following parameters influence the SSI development after laparotomy: colon surgery (OR 8.66 (95 % CI 3.74–21.7); diabetes mellitus (OR 9.36 (95 % CI 4.22–21.65); BMI (OR 1.55 (95 % CI 1.42–1.71) and neutrophil-to-lymphocyte ratio (OR 0.07 (95 % CI 0.03–0.13). A prognostic model for the risk of SSI development was created and programmed as an HTML application using the JavaScript programming language. Conclusion. The incidence of postoperative infectious complications in the surgical site after standard midline laparotomy for elective surgery was 4.93 % (74/1500). The authors created a prediction model to stratify patients according to the risk of SSI development.

Impact of Point-of-Care Laboratory Diagnostics on Emergency Department Processing Times During the COVID-19 Pandemic

Aim: In 2020 Emergency department (ED) in the Clinical hospital centre Rijeka established Point-of-care polymerase chain reaction (POC-PCR) testing for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition to suspect cases, the ED also regularly tested hospital employees. To reduce the number of samples, employee’s swab samples were pooled for testing. This study aimed to analyse the impact of POC-PCR on diagnostic samples’ processing times, evaluated the efficacy of the pooling method among hospital personnel, and determined percentage of false-negative rapid antigen tests (RATs) in comparison with POC-PCR. Materials and Methods: The study included ED patients, hospitalized patients, and hospital personnel. Patients underwent oropharyngeal and nasopharyngeal swabbing. Personnel were screened using the pooling method, combining up to five swabs per test tube. Real time PCR (RT-PCR) was modified to POC-PCR, with or without automated nucleic acid extraction. High-priority patients were tested using the Multiplex PCR QIAstat-Dx Respiratory SARS-CoV-2 Panel. Results: Before the POC-PCR laboratory was established, the median processing times from sample collection to PCR results were 74.29 and 8.35 hours, respectively. Following the establishment of the POC-PCR laboratory in 2021, the median further reduced to 3.25 hours in September 2021, 2.30 hours in September 2022, and eventually reached 1.30 hours in September 2023. Additionally, out of the total 1608 RATs conducted over a 3-month period, 3.4% were false negatives. The pooling method allowed hospital staff samples to be analysed within 2.30 hours, or in the case of a positive pool, within 6 hours of each shift. Multiplex PCR for severe ED patients showed predominant SARS-CoV-2, followed by Rhinovirus/Enterovirus, Influenza, and other Coronaviruses. Conclusion: POC-PCR integration in the ED has significantly reduced time to diagnoses and proved the efficacy of the pooling method, easing the burden on ED and paving the way for further POC-PCR laboratory development.

Comparison of treatment of severe rheumatoid arthritis patients with biological agents and JAK-STAT inhibitors. An extension study.

This study compared treatment with biologic agents and Janus kinase inhibitors (JAKi) in combination with methotrexate (MTX) for rheumatoid arthritis (RA) in a real-world setting at a large center in Poland. There is a persistent shortage of such studies, and illustrating the switching of medications in search of a suitable way of treatment for a given patient is a crucial step towards future personalized therapy. This study is an extension of the initial work published in 2022 in Reumatologia, with the addition of an analysis of patients treated with upadacitinib. The study compared the effectiveness and side effects after treatment of biological disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) in combination with MTX. A total of 130 patients with active severe RA (Disease Activity Score for 28 joints based on the erythrocyte sedimentation rate [DAS28(ESR)] value > 5.1) were treated at the Rheumatologic Outpatients Department of the Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland between January 2010 and September 2021. All patients were treated with MTX 25 mg per week. They were divided into two groups: group I (80 patients) treated with biologic agents, and group II (50 patients) treated with JAKi. Assessment of DAS28(ESR) and Simplified Disease Activity Index (SDAI) and analysis of Boolean criteria for remission were performed. Remission or low disease activity, switching between drugs and adverse events were assessed and compared between studied groups. Patients treated with tsDMARDs had previously used a higher number of conventional synthetic DMARDs (csDMARDs) and bDMARDs compared to those treated with bDMARDs. However, they achieved lower SDAI and assessment of disease activity using Visual Analogue Scale (VAS) values, and a higher proportion of patients achieved Boolean criteria for remission after treatment. The results of treatment with JAKi were successful, but the potential side effects indicate that this treatment may not be equally suitable for all RA patients.

Multiple morcelloma of the peritoneal cavity: a case report

Introduction. Uterine fibroids are benign monoclonal hormone-sensitive tumors arising from smooth muscle cells of the cervix or body uterus. Myomectomyhas become a treatment «golden standard» upon transition to the strategy of organ-preserving surgery. The introduction of morcellation into wide clinical practice allowed to expand the indications for laparoscopic myomectomy, which is usually much better tolerated by patients due to lower invasiveness, short period of rehabilitation and low blood loss. However, the use of morcellators along with the obvious advantages has also specific complications particularly emergence of iatrogenic parasitic fibroids of the abdominal cavity upon improper surgery technique.Aim: analysis of a clinical case of multiple morcelloma.Case presentation. Female patient I., 57 years old, underwent laparoscopic myomectomy in 2003. In 2023 during a routine examination at the Central Clinical Hospital «RZD-Medicine» multiple asymptomatic iatrogenic fibroids of the abdominal cavity were revealed. The patient underwent planned surgical intervention to remove all abnormal masses.Results. During the revision upon surgical intervention, a node of 1.5×1.5 cm was found on the parietal peritoneum along the left anterior wall, as well as a node of 1.5×1.5 cm on the parietal peritoneum along the right anterior wall. There was also observed a 2×3 cm node at the edge of the omentum. In the left and right side of peritoneum of the sacro-uterine ligament, there were found nodes of up to 1 cm in size. In the area of the small intestinal mesentery, a dense node of 4.5 cm was observed 70 cm away from the ileocecal valve. Due to small size, all the fibroids were extirpated and removed from the abdominal cavity without morcellation, complete hemostasis was performed. No complications were noted during postoperative period.Conclusion. Iatrogenic fibroids are quite rare but nevertheless a potential complication of laparoscopic myomectomy. Gynecologists should pay special attention to follow proper technique upon surgical intervention. Morcellation and subsequent extraction of fibroids should be performed strictly with use of airtight container to avoid ingress of myomatous tissue into the abdominal cavity followed by emergence of iatrogenic fibroids.

Significance of Initial Chest CT Severity Score (CTSS) and Patient Characteristics in Predicting Outcomes in Hospitalized COVID-19 Patients: A Single Center Study.

The aim of this study is to examine the prognostic role of initial chest computed tomography severity score index (CTSS) and its association with demographic, socio-epidemiological, and clinical parameters in COVID-19 hospitalized patients. A retrospective study included patients who were hospitalized in the COVID Hospital of the Clinical Hospital Center Kosovska Mitrovica from July 2020 to March 2022. We compared patient characteristics and outcome of their hospital stay with values of CT severity score (mild, moderate, and severe form of the disease). Patients with severe disease were statistically significantly older, they treated more days, and they presented statistically significant highest mortality rate compared to mild and moderate forms. Smokers and obese were significantly more frequent among patients with higher CT, while vaccinated patients were more common among those with a mild form. Biochemical parameters at admission also showed statistical significance between the examined groups. We can conclude that by employing the initial CT severity score as the strongest predictor of mortality, it is possible to predict the outcome in hospitalized patients. A comprehensive examination of the patient upon admission, including determining the extent of inflammatory changes in the lungs using computed tomography, the levels of oxygen saturation, and other laboratory parameters, can assist doctors in making an adequate clinical evaluation and apply appropriate therapeutic protocols in the treatment of COVID-19.

Adult-Onset Still's Disease (AOSD)-On the Basis of Own Cases.

Adult-onset Still's disease (AOSD) is a rare chronic autoinflammatory condition characterized by a spiking fever, arthritis, a rash, hepatosplenomegaly, lymphadenopathy, leucocytosis, and hyperferritinemia. It is sometimes accompanied by life-threatening complications like macrophage activation syndrome/hemophagocytic lymphohistiocytosis (MAS/HLH). Treatment options for AOSD include glucocorticoids (GCs), immunosuppressive drugs, biological medications, and Janus kinase (JAK) inhibitors. The features that differentiate MAS/HLH from AOSD are: in MAS/HLH, a different type of fever, which is persistent, a sharp decrease in the number of leukocytes and thrombocytes, a further increase in the level of transaminases and ferritin, significant hepatosplenomegaly, lymphadenopathy, symptoms of the central nervous system (CNS), disseminated intravascular coagulation (DIC) and hemophagocytosis in the bone marrow. This study aimed to evaluate the course of AOSD, which results in MAS/HLD. Nine AOSD patients, four of whom developed MAS/HLH, were treated at the Rheumatology Clinic in the Central Clinical Hospital of the Ministry of Interior Affairs from 1 January 2015 to 15 March 2020 and at the Rheumatology Clinic in the National Institute of Geriatric, Rheumatology and Rehabilitation from 1 September 2021 to 1 March 2024. Medical history, clinical data, demographic data, laboratory data, imaging data, Hscore, and treatment data were collected. All the patients with MAS and an Hscore above 150 recovered. MAS/HLH requires rapid diagnosis as well as treatment with methylprednisolone pulses, cyclosporine A, and etoposide. When comparing patients who developed MAS/HLH with those who did not, possible risk factors were identified: the presence of pregnancy (two cases) and an aggressive course of AOSD. The Hscore is a useful tool for identifying patients with MAS/HLH.

Infections in Children with Acute Lymphoblastic Leukemia.

Background and Objectives: Infections are the most common and potentially life-threatening complications of the treatment of children with acute lymphoblastic leukemia (ALL). The aim of this study was to determine epidemiological, clinical, and microbiological characteristics of infections in pediatric patients with ALL. Materials and Methods: Twenty-three children (16 males and 7 females, with a mean age of 5.9 years (range of 1.3 to 12.2 years)) with ALL, treated at the Division of Hematology, Oncology, and Clinical Genetics, Department of Pediatrics, Clinical Hospital Center Rijeka, Croatia, from 1 January 2015 to 31 December 2020, were included in the study. Results: One hundred and four infectious episodes (IEs) were reported (an average of 4.5 IE per patient). IEs were more frequent in the intensive phases of antileukemic treatment. Neutropenia was present in 48 IEs (46.2%) with a duration greater than 7 days in 28 IEs (58.3%). The respiratory tract was the most common infection site (48.1%). We documented 49 bacterial (47.1%), 4 viral (3.9%), 4 fungal (3.9%), and 10 mixed isolates (9.6%), while in 37 IEs (35.6%), a pathogen was not isolated. The most common causes of bacteremia were coagulase-positive staphylococci. The most frequent empirical therapy was third- and fourth-generation cephalosporins, followed by piperacillin/tazobactam. The modification of first-line antimicrobial therapy was performed in 56.9% of IEs. Granulocyte-colony stimulating factor was administered in 53.8% of IEs, and intravenous immunoglobulins were administered in 62.5% of IEs. One patient required admission to the intensive care unit. No infection-related mortality was reported. Conclusions: ALL patients have frequent IEs. Close monitoring, the identification of risk factors, the rapid empirical use of antibiotics in febrile neutropenia, and the timely modification of antimicrobial therapy play key roles in reducing infection-related morbidity and mortality in children with ALL.

ABO Blood Type and Urinary Bladder Cancer: Phenotype, Genotype, Allelic Association with a Clinical or Histological Stage and Recurrence Rate.

Background Previous research on connection between the ABO blood group and bladder cancer has been based on determining the ABO phenotype. This specific research is extended to the molecular level, providing more information about particular ABO alleles. Aim To investigate the impact of the ABO blood group genotype or phenotype as a risk factor for urinary bladder cancer. Materials and Methods In the case-control study, we included 74 patients who underwent surgery for a urinary bladder tumor at the Urology Clinic, Clinical Hospital Centre Zagreb, in 2021 and 2022. The control group comprised 142 asymptomatic and healthy blood donors. ABO genotyping to five basic alleles was done using a polymerase chain reaction with sequence-specific primers. We compared ABO phenotypes, genotypes, and alleles between patients and the healthy controls and investigated their distribution according to the clinical and histological stage and recurrence rate. Results No statistically significant difference was found among the groups, nor for the observed disease stages in terms of the phenotype and genotype. At the allele level, the results show a significantly lower proportion of malignancy in O1 ( p < 0.001), A1 ( p < 0.001), and B ( p = 0.013), and a lower proportion of metastatic disease in A2 (0%, p = 0.024). We also found significantly higher proportions of high-grade tumors in patients with O1 (71.4%, p < 0.001), A1 (70.1%, p = 0.019), of nonmuscle invasive tumors in patients with O1 (55.1%, p < 0.001), O2 (100%, p = 0.045), and recurrent tumors in patients with O1 (70.2%, p < 0.001) and A1 (74.2%, p = 0.007) alleles. Conclusion We did not find an association between the ABO blood group genotype or phenotype as a genetic risk factor for urinary bladder cancer. However, an analysis at the allelic level revealed a statistically significant association between certain alleles of the ABO blood group system and urinary bladder tumors, clinical or histological stage, and recurrence rate, respectively.

Neurodevelopmental Outcomes of Very Low Birth Weight Preterm Infants in the Regional Pediatric Clinic

Aim: To examine the incidence and etiology of neurodevelopmental outcomes in very low birth weight preterm infants, maternal and perinatal risk factors, comorbidities, and clinical presentation and compare with newborns of the same gestational age who did not develop a neurodevelopmental disorder.Methods: The research was conducted at the Pediatric Clinic in KBC (Clinical Hospital Center) Osijek. All newborns born from 1 January 2018 to 31 December 2019 with birth weight &amp;lt; 1,500 g and gestational age &amp;lt; 37 weeks are included in the research. The data were collected by reviewing medical records and the hospital’s IT system.Results: In the observed period, 120 children with birth weight &amp;lt; 1,500 g and gestational age &amp;lt; 37 weeks were born. Maternal and perinatal risk factors for premature birth include autoimmune diseases of the mother, infections during pregnancy and birth complications. Early complications that accompany the selected group are RDS, ROP, NEC, IVH, sepsis, congenital heart defects and glucose metabolism disorder. Slowed motor, cognitive and speech development are mostly influenced by low body weight, higher degree of IVH, lower AS in the first minute and the presence of NEC. Significant risk factors for death are gestational age &amp;lt; 25 weeks, body weight &amp;lt; 800 g, infections in pregnancy and autoimmune diseases of the mother.Conclusion: The neurodevelopmental outcome of very low birth weight preterm infants depends on a combination of comorbidities, as well as maternal, perinatal and neonatal risk factors.

Sex-Related Differences in Characteristics and Therapy of Heart Failure Patients

Aim: To determine the differences in comorbidities, therapy and echocardiographic measures among patients hospitalized for heart failure relative to gender.Methods: The study included patients hospitalized for heart failure at the Department of Cardiovascular Diseases of the Clinical Hospital Center Osijek in the period from 1 January 2020 to 30 March 2021.Results: There were 200 patients included in the study, of which 100 (50%) were male and 100 (50%) were female. Female patients were older, while male patients more frequently had a history of coronary artery disease. Men had a higher dose of loop diuretic on admission to the hospital. No significant difference was found in the representation of beta blockers and ACE inhibitors in therapy with regard to gender. On the other hand, men more frequently used MRA, sacubitril/valsartan and antiplatelet medication at hospital admission. Male patients had a larger left ventricular end-diastolic diameter, left ventricular end-systolic diameter and a lower left ventricular ejection fraction (EF). Regarding the type of heart failure according to EF, 72% of men had HFrEF, 20% HFmrEF and 8% HFpEF. In women, 47% had HFrEF, 33% HFmrEF and 20% HFpEF. During hospitalization due to heart failure, 22 patients died, an equal number of men and women.Conclusion: This research confirmed the differences in risk factors and pathophysiology of heart failure between males and females. Medicine is progressing towards an individual approach to each patient, so further research will be needed to find the best therapy for both male and female patients.

Building RadiologyNET: an unsupervised approach to annotating a large-scale multimodal medical database

BackgroundThe use of machine learning in medical diagnosis and treatment has grown significantly in recent years with the development of computer-aided diagnosis systems, often based on annotated medical radiology images. However, the lack of large annotated image datasets remains a major obstacle, as the annotation process is time-consuming and costly. This study aims to overcome this challenge by proposing an automated method for annotating a large database of medical radiology images based on their semantic similarity.ResultsAn automated, unsupervised approach is used to create a large annotated dataset of medical radiology images originating from the Clinical Hospital Centre Rijeka, Croatia. The pipeline is built by data-mining three different types of medical data: images, DICOM metadata and narrative diagnoses. The optimal feature extractors are then integrated into a multimodal representation, which is then clustered to create an automated pipeline for labelling a precursor dataset of 1,337,926 medical images into 50 clusters of visually similar images. The quality of the clusters is assessed by examining their homogeneity and mutual information, taking into account the anatomical region and modality representation.ConclusionsThe results indicate that fusing the embeddings of all three data sources together provides the best results for the task of unsupervised clustering of large-scale medical data and leads to the most concise clusters. Hence, this work marks the initial step towards building a much larger and more fine-grained annotated dataset of medical radiology images.

EARLY ACTIVATION PATHWAYS IN PATIENTS UNDERGOING OPEN HEART SURGERY WITH MULTICOMPONENT GENERAL ANESTHESIA COMBINED WITH HIGH THORACIC EPIDURAL ANESTHESIA

Background: Early mobilization of patients in the postoperative period after open heart surgeries, significantly decreases the risk of complications, accelerates the restoration of functional capacity, shortens the length of hospital stay, and reduces treatment costs Materials and methods: Open heart surgeries were performed on 60 patients at Ankara "Bayındır" Hospital, Central Clinical Hospital, and Baku Health Center were included in the study. Patients were divided into two groups. 30 of them underwent the procedure with the use of multi-component balanced general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization under high thoracic epidural anesthesia, with the administration of ropivacaine prior to induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects. Results: Thirty of them underwent the procedure with the use of multi-component general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization of the high epidural space with the administration of ropivacaine before induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects. Conclusion: It has been established that for patients in the second group according to the Enhanced Recovery After Surgery strategy, hemodynamic support and effective pain management can contribute to early patient mobilization after surgery. Early mobilization, in turn, can expedite recovery and reduce the length of hospital stay, ultimately leading to potential cost savings.

Percepcija roditelja o febrilnim konvulzijama u djece

Aim. To examine the perception of parents of children suffering from febrile seizures in relation to management procedures for febrile seizures, parents’ gender, and their opinion regarding the need for additional education.Methods. The cross-sectional study was conducted at the Department of Pediatrics, Osijek Clinical Hospital Centre, in February and March 2023. The respondents were 32 parents of children hospitalized for febrile seizures. A questionnaire on parents’ perception of febrile seizures was used.Results. There were 32 respondents, 15 (47%) male and 17 (53%) female. A total of 20 (62%) respondents were not aware that their child was having a febrile seizure attack, 6 (19%) respondents thought their child was dying, and 4 (13%) respondents thought their child was losing consciousness. During seizure, a significant number of respondents, 16 (50%), of them, felt fear as the dominant emotion, and 13 (41%) respondents felt panic. A total of 9 (28%) respondents felt ready for recurrent febrile seizure, while 6 (19%) respondents were not or could not assess their readiness. A total of 29 (91%) respondents believed that they needed additional education.Conclusion. Parents are mostly unaware that their child is having a febrile seizure and feel fear and panic. Male parents call emergency medical services significantly more often than female parents. Parents are not sufficiently prepared for the recurrent seizures, and most of them believe that they need additional education.

Abstract PO1-28-05: Preventive Microsurgery in Breast Cancer Treatment

Abstract Relevance: Breast cancer (breast cancer) ranks first among all oncological diseases in women in the world. In 2020, 2.3 million people worldwide were diagnosed with breast cancer. The most common complication after radical breast surgery is violation of lymph outflow in the form of lymphatic edema (lymphedema) of the limb. The probability of developing lymphedema according to scientific literature is from 12 to 60%. Treatment of this complication is carried out conservatively and surgically. According to a review of international experience, a preventive microsurgical technique for restoring lymph outflow from the upper limb – the application of lymphovenous anastomoses (LVA) has a positive result for the prevention of lymphedema, similar to a sentinel lymph node biopsy and can be considered as an addition to standard axillary lymph dissection (ALD). Objective: To evaluate the effectiveness of preventive microsurgical application of LVA after ALD in breast cancer. Methods: From August 2022 to June 2023, 44 operations were performed with preventive microsurgical application of lymphovenous anastomoses on the basis of the Department of Tumors of the Female Reproductive System of the Central Clinical Hospital “RZD-Medicine”, Moscow. In 39 patients, surgery was performed during the primary treatment: disease stage cT1-4N1-3M0. Organ-preserving resection with lymph node dissection (9),mastectomy with lymph node dissection (30). In 14 patients, a biopsy of the sentinel lymph node was performed at the first stage; according to the result of a lesion of 2 or more, ALD and LVA were performed. In 5 patients, ALD was performed for local recurrence of the disease in the axillary region. All patients underwent immediate microsurgical restoration of lymphatic outflow from the upper limb during one operation in the axillary region after the stage of lymph node dissection. A fluorescent dye was used for reverse mapping of lymphatic pathways from the upper limb. Isotopes + fluorescent dye were used to determine the sentinel lymph node. Lymphatic venous anastomoses were applied end-to-end, end-to-side, side-to-side and by the Optocus technique. Results: The median follow-up was 5.5 months. The duration of the operation increased by an average of 70 minutes: at the same time, the ALD time increased by an average of 14 minutes for gentle skeletization of the veins for the subsequent application of LVA. In 4 patients, the integrity of the recipient vein was damaged during lymph node dissection and restored microsurgically. No surgical complications were observed. The average duration of lymphorrhea in the postoperative period was 2.3 days (without LVA 13.9 days). Conclusions: The preventive microsurgical technique for restoring lymph drainage from the upper limb has a number of technical limitations, requires special training and microsurgical equipment. Nevertheless, the technique is safe, feasible and effective in the early postoperative period. The application of LVA led to a significant decrease in lymphorrhea in the postoperative period, a reduction in hospital stay, but an increase in the duration of the operation. Longer follow-up is required to assess the overall effect of LVA on the incidence of lymphedema. Citation Format: Vladimir Vorotnikov, Alexander Soynov, Alexander Soynov, Regina Pakhomova, Alexandra Gugnina, Sardor Abdugafforov, Sofia Kim, Tornike Mchedlidze. Preventive Microsurgery in Breast Cancer Treatment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-28-05.

Covid-19 impact on femoral fragility fractures treatment: overview and comparison of 4 years of treatment at Geriatric Department of Trauma Clinic of Sestre milosrdnice Clinical Hospital Center

Covid-19 impact on femoral fragility fractures treatment: overview and comparison of 4 years of treatment at Geriatric Department of Trauma Clinic of Sestre milosrdnice Clinical Hospital Center

To 110th anniversary of cardiac surgeon and researcher Igor N. Meshalkin

Igor N. Meshalkin (1913–1996) was Soviet cardiac surgeon, Dr. Sci. (Medicine). He was a graduate of the 2nd Moscow State Medical Institute (2nd MSMI, now the N.I. Pirogov Russian National Research Medical University). He was a participant in the Great Patriotic War. Igor N. Meshalkin began his professional career as a medical resident and an assistant of the clinic of faculty surgery in the 2nd MSMI since 1947; then as a medical resident of the Main Military Hospital of the Armed Forces of the USSR since 1951 and an assistant of the general surgery department of the pediatric faculty in the 2nd MSMI since 1954. In 1958–1963, he headed the Department of Acquired Heart Diseases in the Institute of Experimental Biology and Medicine (now the E.N. Meshalkin National Medical Research Center). In 1963–1977, Igor N. Meshalkin was the head of the department in the Central Clinical Hospital of the 4th Main Directorate of the USSR Ministry of Health. His research interests were focused on urgent abdominal surgery, thoracic surgery, mitral stenosis surgery. Igor N. Meshalkin was the author of 55 scientific works including two monographs. Received 8 November 2023. Accepted 14 November 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article. Acknowledgment: The authors would like to thank Marina, daughter of Igor N. Meshalkin, for providing personal documents and photographs.