Clinical Hospital Centre Osijek Research Articles

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.

Informing and Preparing Patients for Echocardiography

Aim. To examine the awareness and preparedness of patients for echocardiography regarding age, gender, education level, and the type of examination. Methods. A cross-sectional study included patients who came for echocardiography through the outpatient clinic and Clinical Departments of the Clinical Hospital Center Osijek during March and April 2023. A survey questionnaire developed for this research was used as the research instrument on patients’ awareness and preparedness for echocardiography. Results. The study included 106 participants, of which 52 (49%) were males and 54 (51%) were females, with 51% of them having undergone 1 – 3 echocardiographic examinations before. Most participants, 83 (78%), received information verbally. There was no significant difference in the awareness and preparation of participants for echocardiography regarding gender and age. Participants with higher education levels agreed that they knew how the examination was conducted before coming, unlike participants with lower levels of education, and there was a significant statistical difference between the groups (p=0.02). Participants who underwent transesophageal echocardiography stated that they were better informed and prepared compared to those who underwent transthoracic echocardiography (p=0.01). Conclusion. The results of the conducted research indicate that participants are well informed and prepared for echocardiographic examinations, with no significant differences based on gender and age. Participants who underwent transesophageal ultrasound of the heart considered themselves better informed and prepared compared to those who underwent transthoracic echocardiography.

Prevalence of familial hypercholesterolemia in patients with acute coronary syndrome

<p><strong>Aim <br /></strong>To investigate the prevalence of familial hypercholesterolemia in patients with acute coronary syndrome (ACS).<br /><strong>Methods</strong> <br />The study included fifteen patients with first or repeated ACS and treated/nontreated dyslipidaemia admitted to the Department of Cardiovascular Diseases of Clinical Hospital Centre Osijek between 1 January 2020 and 1 January 2021. The cut-off value of low-density lipoprotein (LDL)-C was 4.5mmol/L as a possible cut-off value for familial hypercholesterolemia presence. Data were collected from medical history and during patient’s follow-up.<br /><strong>Results</strong> <br />Included patients that fulfilled criteria were predominantly male – 14 (93%), mean age 61 years. The median level of LDL cholesterol at admission because of ACS was 5.14 mmol/L, whereas the follow-up level after one year was 2.27 mmol/L (p=0.001). At first follow-up, 7 (46%) patients were treated with atorvastatin 80 mg or rosuvastatin 40 mg, 3 (20%) atorvastatin 80mg + ezetimibe 10mg, 2 (13%) with rosuvastatin 40 mg+ ezetimibe 10 mg, other patients were treated with a lower dose of statin or ezetimibe. According to LDL-C profile and by calculating the<br />Dutch Lipid Clinic Network Score, one (of 15) patient was categorized as having definite familial hypercholesterolemia and two (of 15) as having probable familial hypercholesterolemia leading to the use of triple hypolipidemic therapy (statin+ezetimibe+PCSK9 inhibitor) in 2 (13%) patients (one female and one male).<br /><strong>Conclusion</strong> <br />LDL-C level of 4.5 mmol/L and higher represents an indication for screening for familial hypercholesterolemia in patients with ACS. The prevalence of familial hypercholesterolemia in ACS, estimated by the Dutch Lipid Clinic Network Score, could be higher than previously reported.</p>

Impact of Immediate and Delayed Breast Reconstruction on Quality of Life of Breast Cancer Patients.

A mastectomy affects the psychological, social, and sexual well-being of patients. Research has confirmed that breast reconstruction is important for improving the quality of life in patients with breast cancer. The aim of this study was to assess the quality of life of patients who underwent a mastectomy followed by immediate or delayed breast reconstruction. This prospective study was conducted from January 2018 to March 2020 at the Clinical Hospital Center Osijek, using the health questionnaire SF-36. The study included 79 patients. The results of the study showed that patients who underwent a mastectomy had the lowest scores in the domain of restriction due to physical difficulties, 18.8 (6.3–31.3), in physical functioning and limitation due to emotional difficulties, 16.7 (8.3–33.3), in mental health. In immediate breast reconstruction, patients rated better physical health (p < 0.001), while patients who underwent delayed breast reconstruction rated their mental health worse (p < 0.001) as measured by the SF-36 questionnaire. Conclusion: The results of this study show that patients without breast reconstruction rated their quality of life worse than patients who underwent immediate and delayed breast reconstruction after mastectomy. There is no difference in the quality of life between patients who underwent immediate and delayed breast reconstruction after mastectomy.

The Level of Empathy and Psychological Distress in Nurses and Health Technicians

The aim of the study was to examine the overall level of empathy, its affective and cognitive aspects, the level of psychological stress, and to determine the relationship between empathy, emotions and psychological stress in nurses and health technicians employed at the Clinical Hospital Center Osijek. A cross-sectional study was conducted from March to June 2019 among 152 nurses and health technicians using the authors personally prepared questionnaire, and standard questionnaires BES, PANAS and K10 to evaluate empathy, positive and negative emotions and psychological distress of respondents. Respondents exhibited a middle – a higher degree of total empathy (median 50 and interquartile range of 43–56), with more emphasized affective than cognitive component. Psychological distress was confirmed in 65% of respondents. There was a correlation between affective and cognitive empathy (p&amp;lt;0.001, r = 0.355). People with a higher degree of distress also had more negative emotions that tended to increase with increasing distress (p &amp;lt;0.001, r = 0.426). Healthcare workers are mostly empathic and in a great deal exhibit psychological distress. It is necessary to carry out systematic surveys among health personnel to determine the empathy and distress levels to detect the risk groups who need help with stress prevention.

MEDICINE IN OSIJEK DURING THE REIGN OF FRANZ JOSEPH I – THE ESTABLISHMENT OF THE HUTTLER-KOLHOFFER-MONSPERGER FOUNDATION HOSPITAL

The Austrian emperor and the Croat-Hungarian king Franz Joseph I (1830/1848-1916) was the longest-serving ruler of the Habsburg dynasty. Among his properties was Osijek, which since 1809 enjoyed the status of a free royal city. In the period under review, it was the seat of the Virovitica County and the capital of the Kingdom of Slavonia until its incorporation into the Triune Kingdom of Croatia, Slavonia and Dalmatia after the Croat-Hungarian settlement of 1868. Because of this, Osijek was not only a political, economic and cultural centre but also a health care centre. At the beginning of the reign of Franz Joseph I, two hospitals were operating in it: a military one in the baroque military garrison Tvrđa and a civilian one in New Town. The most significant role in the further development of the Osijek and Slavonian health care was played by the trust established in 1806 from the legacies of innkeeper Johann Kolhoffer, tanner Josef Huttler and Jesuit Cristian Monsperger. Although originally intended for the establishment of an orphanage, due to a number of unfavourable political circumstances, the trust, until then with multiple interests attributed to the principal, came under the administration of the city of Osijek only in 1867. Along with the new orphanage opened in 1874, a new hospital was completed as well in 1868, also with the money from the trust. Huttler-Kohlhoffer-Monsperger Foundation Hospital was the largest and most modern hospital in the Triune Kingdom, and despite later constructions of various hospital wards, its building has remained the most representative building within the Clinical-Hospital Centre Osijek.

Postmortem injury quantification for the fatally injured cyclists in the Osijek–Baranja county over a 21-year period

Objective The objective of this study was to quantify injuries in fatal cyclists’ traffic crashes by performing injury analysis and determine injury trends as well as main epidemiological data of the cyclists’ fatalities. Methods The study was organized as a cross-sectional retrospective study, which included 125 cyclists’ fatalities autopsied at the Clinical Department of Pathology and Forensic Medicine, Clinical Hospital Center Osijek from 1998 to 2018. We applied The Abbreviated Injury Scale (AIS©) classification for all fatally injured cyclists in traffic crashes and determined the severity of injuries by body region from the description of injuries reported in the autopsy report. Results The majority of victims in our study (80%) were male and older than 45 (80.8%). A significant majority of cyclists (78.4%) were not wearing a helmet at the time of the fatal crash. For the rest of the cyclists (21.6%) we were not able to establish if they were wearing a helmet at the time of the crash based on the traffic police reports. Most of those who died on the spot or during transport had severe injuries to three or more ISS body regions (26/46 = 54%) and the majority of deceased cyclist had severe injuries to the head and brain, regardless of the time of death. Older cyclists died on the spot with lower injury severity scores (ISS). Conclusions Measures against dangerous cycling behavior such as driving under the influence of alcohol and driving without the helmet could lead to reduction of fatal, and probably, non-fatal bicycle crashes. We believe that policy change regarding mandatory helmet usage is of upmost importance. Injury analysis can provide us with valuable information regarding where the focus of treatment should be among severely injured cyclists as well as where the prevention should be targeted. Further injury analysis studies are needed, with studies including both fatal and non-fatal crashes. The Abbreviated Injury Scale represents a valuable system for describing (coding) and quantifying the severity of injuries during autopsies.

Psychometric properties of the Croatian version of the multiple sclerosis international quality of life questionnaire

Background Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system that results in a wide range of clinical manifestations and has a great impact on patient health-related quality of life (HRQoL). Objective The aim of this study was to determine the psychometric properties of the Croatian version of the Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire. Patients and methods In this research was analysed data of 82 MS patients (51 women and 31 man, average 42.6±11.9 years) which underwent neurological care at Clinical Hospital Centre Osijek, Croatia. Our research problem was examined using the multidimensional and self-administrated MusiQoL questionnaire. The data was descriptively analysed and internal consistency reliability was assessed by Chronbach’s alpha coefficient. Pearson’s correlation was performed on the MusiQoL index score and dimension scores of the MusiQoL questionnaire. The level of significance was set to p Results Cronbach’s alpha for the MusiQoL total score using the entire sample was 0.93, indicating a high internal consistency. Also, all MusiQoL dimensions demonstrated a high internal consistency (Chronbach’s alpha: 0.75-0.95). The MusiQoL index score significantly correlated with all MusiQoL dimension scores (Pearson’s correlation: 0.43-0.86). Conclusion The Croatian version of the MusiQoL questionnaire can be a valid and reliable instrument for measuring QoL in Croatian-speaking MS patients and constitutes a useful instrument to measure HRQoL in the clinical setting.

CN91 - Examining the benefits of medical exercise during radiotherapy in patients after mastectomy

BackgroundBreast cancer is the second leading cause of cancer deaths among women. Most women with breast cancer undergo surgery and chemotherapy and/or radiotherapy. These treatments trigger various side effects, for example, shoulder immobility, numbness or tightness, and lymphedema of the arm. Exercise-induced adaptations and better muscular performance may attenuate mentioned symptoms and side effects. The aim of this research is to determine whether there is correlation between physical exercise and the relief of symptoms predominating during radiotherapy. MethodsStudy was designed as a longitudinal sudy. The participants were female patients hospitalized at Department for Oncology at Clinical Hospital Centre Osijek, with diagnosed breast cancer, who were treated with radiotherapy after mastectomy. Research was conducted with an anonymous questionnaire, designed for the purpose of this study. ResultsThere were total of 36 respondents. There was correlation between feeling of worry about the course of the disease in the beginning and the end of treatment with opinion that targeted exercises will reduce the worry (Spearman’s rho 0,630, P<0,001). Also, there was correlation between with opinion that targeted exercises will reduce the anger and assessment that exercises reduced that feeling (Spearman’s rho 0,625, P<0,001). After the treatment, most of the respondents evaluated the benefit from exercise in reducing pain, anger, fear and worry with 4 on a scale from 1 do 5, and they evaluated the feeling that exercises helped them with grade 5 on a scale from 1 do 5. The majority of respondents expressed that they will continue to exercise at home. ConclusionsIn general, respondents had good attitudes toward physical activity. Most of them exercise few times weekly and they think that exercise is useful. They strongly agreed that they would recommend the exercise to other patients who are suffering from this disease, that they feel that exercises helped them and that their attitude about the importance of exercise changed in a positive direction. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Pulmonary contusions after blunt chest trauma: clinical significance and evaluation of patient management.

A pulmonary contusion is an entity defined as alveolar haemorrhage and pulmonary parenchymal destruction after blunt chest trauma. According to the literature, most pulmonary contusions can only be seen on a chest CT. The aim of this study was to evaluate the patients with pulmonary contusions, as well as their management, considering diagnostic and therapeutic options related to their outcomes, since we assumed, based on everyday clinical practice, that an 'overdiagnosing' and 'overtreatment' attitude towards this injury could be present. The research was a retrospective study including 5042 patients admitted to the Department of Traumatology in the Clinical Hospital Centre Osijek, during a 3-year period. The medical data of the patients who suffered pulmonary contusion were evaluated considering significant characteristics, known risk factors, procedures undergone, and outcomes. During the 3-year period, 2% of all the admitted patients were diagnosed with a pulmonary contusion. In 54% of the cases, the patient suffered polytraumatic injuries. The pulmonary contusion was an isolated injury in 7% of the patients. In 31% of the cases, there was no liquidothorax or pneumothorax (isolated pulmonary contusion). In 89% of the patients the pulmonary contusion was diagnosed using a CT scan. In 68% of the patients there were no interventions regarding the thorax; thoracocentesis was performed in 25% of the cases, and pleural punction in 14% of the cases. 25% of the patients developed respiratory insufficiency and 16% required mechanical ventilation. Regarding isolated pulmonary contusions, respiratory insufficiency was present in 8% of the cases. We suggest that a pulmonary contusion seen on CT only has limited clinical significance and that the use of CT scans in diagnosing and follow-up of these patients should be re-evaluated. Further prospective and randomised studies should be conducted and the patients should be clinically evaluated, with the administration of supportive and antibiotic therapy, maintaining the fluid balance, the administration of diuretics, supportive oxygen therapy, pulmonary toilet, and physical therapy.

Pharmacoeconomic Analysis of Different Biologic Therapies in Inflammatory Bowel Disease Patients in 1 Tertiary Center in Croatia

Table: Table. Results of pharmacoeconomic analysis of different biologic therapiesIntroduction: Biologics are used in patients with inflammatory bowel disease (IBD) usually after failure of conventional therapy, or, sometimes, instead of it early in the disease course. In Croatia, in the treatment of IBD, anti-tumor necrosis factor alpha (anti-TNF) agents infliximab, adalimumab and golimumab, and anti-integrin antibody vedolizumab are available. In patients achieving remission with anti-TNFs, loss of response should be treated firstly by dose optimization (dose increase or interval shortening). Our aim was to compare costs of different biologic therapies considering the costs of dose optimization. Methods: During March of 2017, we collected data of 91 patients with Crohn's disease and ulcerative colitis currently receiving biologic therapy at the Department of Gastroenterology and Hepatology of Clinical Hospital Center Osijek, Croatia. Data of our interest were: diagnosis, drug used, date of first and last drug application, projected date of next application, drug dosage of last application, and data of whether patient is receiving induction or maintenance therapy. We calculated the projected yearly cost of maintenance therapy with each biologic drug including costs of dose optimization. Projected yearly costs of maintenance therapy with different biologics were then compared. Drug prices were obtained from currently active list of medications of Croatian Health Insurance Fund. Results: 19% of our patients on infliximab and 26% of our patients on adalimumab had dose optimization due to loss of response. Projected average yearly dose per patient for infliximab considering dose optimization is 3053 mg/y compared to yearly dose recommended in summary of product characteristics (SmPC), which is 2600 mg/y. For adalimumab, projected average yearly dose per patient considering dose optimization is 1337 mg/y compared to 1040 mg/y recommended in SmPC. Projected cost of maintenance therapy per year after dose optimization is 1.2 times higher (13937 vs. 11868 USD) for infliximab and 1.3 times higher (17449 vs. 13571 USD) for adalimumab when comparing to costs of maintenance therapy in doses recommended in SmPC. Results are presented in table 1. Conclusion: As our results show, costs of maintenance therapy for certain biologics are higher when considering dose optimization. Inclusion of costs of dose optimization would give more accurate calculation of different biologic therapy costs and would help in understanding of pharmacoeconomic justification of use of different biologic therapies.

Prognostic significance of specific injury patterns in casualties of traffic-related accidents.

Fatal triad and ipsilateral dyad are patterns of pedestrian injuries related to significant mortality in traffic-related accidents. The aim of this research was to investigate the correlation between specific injury patterns and fatal outcome in other participants of traffic-related accidents. This was a retrospective study of traffic-related accidents in the broader area of the city of Osijek in a five-year period from 1995 to 1999. Autopsy results from the Institute of Pathology and Forensic Medicine of the Clinical Hospital Centre Osijek were analysed of individuals who died after their accident. The total severity of injuries was measured using the ISS. Logistic regression analysis was used for assessing the correlation between specific injury patterns and an early outcome from the severe injury. There were 213 individuals included in the study: 72 pedestrians and 141 other participants (drivers, assistant drivers, passengers, cyclists and motorcyclists). A total of129 individuals died on the spot and 84 died in the hospital during the first 48h. Femoral and pelvic fracture, fatal triad and both variants of ipsilateral dyad were related to higher ISS values. Ipsilateral fracture of upper and lower extremities (ipsilateral dyad 1) was associated with a 4.59 times higher risk of an immediate fatal outcome in the total sample. In pedestrians, the risk was 5.99 higher, and in other participants, the risk was 4.11 times higher. Specific skeletal injuries and injury patterns are a significant indicator for total injury severity and related poor prognosis for all participants of traffic-related injuries, not only for pedestrians. In this study, the ipsilateral fracture of upper and lower extremity was related to the largest total severity of injuries and the poorest prognosis.

Depression, Personality and Life Stress Among Women with Breast Cancer in Eastern Croatian Region

Breast cancer is the most common among women and representsthe overall leading cancer in mortality rates. There is more than million newlydiagnosed breast cancer in the world every year. Incidence of breast cancer inCroatia is 100/100 000 or 2300 women per year. Every year, in Croatia, 900women die due to this carcinoma. Breast carcinoma is mostly found in women ages45-60. As the depression rates grow higher every year it isimportant to address the fact that among women with breast cancer the depressivesymptomes or depressive disorder is three times higher. These symptomes areoften correlated with stress (various life events), personality traits, sociodemographics and course of the primary disease (breast cancer). We have conducted a research among eighty (N=80)premenopausal women (40-60 years) withdiagnosed breast cancer shortly (3-7 days) after surgical treatment. Exclusion criteria was any kind of earliermental illness or psychiatric treatment/therapy . This research was conductedon Clinic for Surgery, Department of Thoracic surgery in the Clinical HospitalCentre Osijek (Croatia) and following questionnaires were applied: Hamiltondepression rating scale; Temperament and Character Inventory and Life Change Index Scale – The Stress Test. The obtained results were showed new perspective in dealingwith this disease, especially in this eastern Croatian region, and need forinterdisciplinary approach since significantly high ratio of women showeddepressive simptomes due to negative results correlated with stress and poorsocial/family support and also with specific personality features.

Premedication with midazolam is equally effective via the sublingual and intravenous route of administration

Background. The aim of this study was to investigate the clinical efficacy and potential side effects of sublingual midazolam, used for premedication, in comparison with intravenous midazolam. The second aim was to explore cost-effectiveness of sublingual midazolam administration.Methods. A prospective, randomized, controlled, single-blinded trial was conducted at the Clinical Hospital Centre Osijek, Croatia, during the period 1st of May till 31st of October, 2012. We enrolled 140 patients (American Society of Anesthesio-logists (ASA) physical status I-II, age≥18 years) scheduled for some kind of elective surgical procedure. Exclusion criteria were ASA III or higher, psychiatric disorders, allergy to midazolam and use of psychotropic drugs. Patients were randomi-zed into one of two groups. One group received 2.5 mg of midazolam intravenously and the other group received 1/4 of a midazolam tablet (approximately 3.75 mg) sublingually. Sedation was clinically evaluated using the Ramsey sedation scale at 0, 10, 20 and 30 minutes after drug administration. We also noted side effects and degree of amnesia.Results. Ten minutes after administration of premedication, a significantly higher number of patients in the intravenous group had a Ramsey score of 2 (p=0.000). Ten and twenty minutes after drug administration, most of the patients in the sublingual group had a Ramsey score 1-2, and after 30 minutes most of them had a Ramsey score 2-3, which is comparable with the intravenous (p=0.642) group. Conclusion. Sublingual application of midazolam has an equivalent sedative effect as intravenous midazolam 20 minutes after administration but is associated with a bitter taste and weaker amnestic effect.

Transcranial sonography and pocket smell test in differing Parkinson'/INS;s disease from essential tremor

WCN 2013 No: 1833 Topic: 2 — Movement Disorders Transcranial sonography and pocket smell test in differing Parkinson's disease from essential tremor I.S. Bradvica, S.B. Soldo, D. Janculjak, I. Mihaljevic, M. Titlic. Neurology, Clinical Hospital Center Osijek, Osijek, Croatia; Department for Nuclear Medicine and Radiation Protection, Clinical Hospital Center Osijek, Osijek, Croatia; Department for Neurology, Clinical Hospital Center Split, Split, Croatia Introduction: We wanted to determine the specificity and sensitivity of transcranial sonography (TCS) and Pocket Smell Test (PST) in differing Parkinson's disease (PD) from essential tremor (ET). We also wanted to compare these methods with the specificity and sensitivity of DaTSCAN used as a gold standard. Patients andmethods: In this study we included 110 patients with the symptomatology of parkinsonism present in the last 6 to 12 months. According to the DaTSCAN results, patients were divided into two groups. The PST was performed to evaluate the olfactory dysfunction. Using TCS the possible substantia nigra hyperechogenicitywas encircled and measured. The sensitivity and specificity of PST and TCS were calculated. Results: From 110 patients, 51 (46.4%) patients had ET and 59 (53.6%) patients suffered from PD. Olfactory dysfunction was present in 44 (74.6%) patients with PD, and in 10 with ET. The specificity of PST is 80.39%, and the sensitivity is 74.58%. The hyperechogenicity of the substantia nigra was predominantly found in patients with Parkinson's disease. The specificity of TCS is 88.2%, and the sensitivity is 94.9% in confirming Parkinson's disease. Conclusion: We suggest that it would be useful to perform these methods routinely in the everyday practice as a good screening protocol before indicating DaTSCAN. doi:10.1016/j.jns.2013.07.613 Abstract — WCN 2013 No: 1831 Topic: 2 — Movement Disorders Eye of the tiger sign in a patient with levodopa-induced motor complications WCN 2013 No: 1831 Topic: 2 — Movement Disorders Eye of the tiger sign in a patient with levodopa-induced motor complications C. Pires, H. Nzwalo, S. Reimao, L.C. Guedes, M.M. Rosa, M. Coelho. Department of Neurology, Hospital do Divino Espirito Santo, Ponta Delgada, Lisbon, Portugal; Department of Neurology, Hospital de Faro, Faro, Lisbon, Portugal; Department of Neuroradiology, Hospital de Santa Maria, Lisbon, Portugal; Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal; Institute ofMolecularMedicine, Faculty ofMedicine,

Treatment possibilities of basal ganglia hemorrhage: Retrospective trial of fifty-four patients

WCN 2013 No: 2498 Topic: 3 — Stroke Treatment possibilities of basal ganglia hemorrhage: Retrospective trial of fifty-four patients A. Soldo, N. Koruga, S. Butkovic Soldo, D. Stimac, I. Hecimovic. Neurology, Clinical Hospital Center Osijek, Osijek, Croatia; Neurosurgery, Clinical Hospital Center Osijek, Osijek, Croatia Background: Intracerebral hemorrhage presents a challenge for both neurologists and neurosurgeons and constitutes up to 15% of the total number of cerebrovascular incidents. Objective: The aim of this trial is to present an outcome of conservative and surgical treatment of intracerebral hemorrhage in our hospital. Patients and methods: All patients underwent CT on admission. The treatment depended on CT confirming intracerebral hemorrhage and regarding progressive neurological deterioration of consciousness, brain edema or shift effect. These patients underwent a prompt surgical treatment with decompressive craniotomy and clot removal or external ventricular drainage as standard approach. The other patients underwent conservative treatment which consisted of antiedematous therapy and blood pressure regulation. Results: In a group of fifty-four patients, fifty-one patients were treated conservatively and three patients were treated surgically. Conservatively treated patients and three patients treated surgically showed clinical improvement with satisfying additional postoperative CT scan within 48–72 h. Conclusion: The trial showed that there is no difference between conservative and surgical treatment, although surgical treatment was superior in cases of progressive neurological deterioration with GCS 5–11. According to our retrospective trial, we can conclude that there was no significant difference between conservative and surgical treatment during the follow-up period of three months. doi:10.1016/j.jns.2013.07.943 Abstract — WCN 2013 No: 2477 Topic: 3 — Stroke Impact of heat shock protein on ischemic stroke risk Z. Banecka-Majkutewicz, R. Hebel, A. Papkov, A. Wegrzyn, B. Banecki, W.M. Nyka. Department of Neurology, Medical University of Gdansk, Poland; Department of Molecular and Cellular Biology, University of Gdansk, Gdansk, Poland; Department of Microbiology, University of Szczecin, Szczecin, Poland Heat shock protein 72 (HSP72) has been found to reduce ischemic injury. HSP72 itself may be a marker for neuroprotection in ischemic stroke. The aim of the study was to investigate the association between HSP plasma concentration and risk of ischemic stroke. We also investigated MTHFR and CBS genotypes. Methods: We have measured the level of antibodies against HSPs in vitro, in serum of ischemic stroke patients and control group using ELISA. We study the prevalence of MTHFR (C677T, A1298T) and CBS (T833C, insertion 68 bp in position 844) genotypes. Results: Heterozygotic genotype C677T of MTHFR was detected in 45% of patients, and A1298T in 43%. 5% of homozygotic C677C and 8% of T1298T were detected. In 87.5% of subjects at least one heterozygotic mutation was detected. Hyperhcy was correlated with mutations in either gene (p= 0.04). The level of antibodies against one of the bacterial HSPs, GroEL, correlates with the level of serum hcy. It points at the possible significance of autoimmune reactions contributing to atherosclerosis. We have also purified MTHFR and tested the influence of HSPs of the KJEB system in vitro, using spectrophotometric test for MTHFR activity. We found that MTHFR is partially protected from the effect of heat shock by KJEB system and that KJEB proteins can restore that activity of the enzyme when it is lost due to thermal denaturation. Conclusions:Our study confirmsdiagnostic significance of antibodies to HSP in stroke. HSPs can be involved in the development of atherosclerosis, as well as protection against stroke. doi:10.1016/j.jns.2013.07.944 Abstract — WCN 2013 No: 2463 Topic: 3 — Stroke Tympanic temperature matches the brain temperature, fact or fiction? WCN 2013 No: 2463 Topic: 3 — Stroke Tympanic temperature matches the brain temperature, fact or fiction? P. Kordestani Moghadam, P. Mirzavand, F. Manteghi. ICSS, Institute for Cognitive Science Studies, Tehran, Iran; LUMS, Lorestan University of Medical Sciences, Iran; ICU of Shohada Hospital, LUMS, Lorestan University of Medical Sciences, Khorramabad, Iran This study is a case series, which was conducted on 10 CVA patients whowere admitted in the ICUward. These subjects consist of unilateral or bilateral ICH. GCS, vital sign and tympanic temperature were controlled for the subjects within one week. Tympanic temperature measured from the left and the right ear. After this time we observed the meaningful difference between the left and the right tympanic temperature in patients with a unilateral lesion, but this difference was not seen in patients with bilateral lesions. Based on these results, it seems that we used tympanic temperature in early diagnosis of hemorrhagic lesion in the affected side of the brain, just as the case in unilateral hemorrhagic lesion in patients with different etiologies. doi:10.1016/j.jns.2013.07.945 Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278 e243

Incidence of tricuspid regurgitation and the total number of tricuspid valve surgery in patients with mitral valve disease at Clinical Hospital Center Osijek

Incidence of tricuspid regurgitation and the total number of tricuspid valve surgery in patients with mitral valve disease at Clinical Hospital Center Osijek

P-0151 Colorectal Cancer Screening – Results of Colonoscopy in the Osijek-Baranja County, Croatia

ABSTRACT Introduction Colorectal cancer (CRC) is the third most prevalent human cancer worldwide, with 1 million estimated new cases annually. The National Program of Prevention and Early Detection of Colorectal Cancer started in November 2007. The screening method for early detection of colorectal cancer is the Faecal Occult Blood Test (FOBT). The target population is an asymptomatic population at average risk, aged 50-74. The expected time of one screening cycle was extended from 2 to 4 years because of the technical difficulties in implementing the Program. Invitation letters have been sent by mail. There are three FOBT with instructions for their use, a questionnaire about risk factors and an educational brochure in each envelope. Invited people have been asked to mail applied testing-cards back, together with a filled out questionnaire. People testing positive are invited for colonoscopy in the Clinical Hospital Centre Osijek. Methods The individuals who tested positive for FOBT accepted a colonoscopy examination. During the colonoscopy examination premalignant lesions are removed and the samples are sent for histopathological analysis. Patients are called in to the Clinical Hospital Centre Osijek for a check-up when the gastroenterologist decides on further treatment depending on the results of the analysis. The colonoscopy results are collected and analysed in the Institute of Public health. Results Until February 2012 we sent FOBT to 75.021 individuals (71% of target population). The responding rates are 20.3%. The percent of FOBT positive tests were 9.6%. From 1.412 individuals who were invited 968 underwent a colonoscopy. 87.5% had a pathological finding. There are 68 newly discovered carcinomas (7.0% of those who underwent colonoscopy), 474 polyps (49.0%), 173 haemorrhoids (17.9%), 85 diverticula (8.8%) and 47 other diagnoses (4.9%). 121 individuals were without a pathological finding (12.5%). Conclusion It is necessary to increase public awareness about colorectal cancer. With higher response rates more cancers and premalignant lesions in the population will be detected. The detection of cancer in early stages increases the survival rate and quality of life.

Consumption of intravenous immunoglobulins in Clinical Hospital Center Osijek 2006-2010

BackgroundRetrospective analysis of the use of intravenous immunoglobulins (IVIG) in our hospital. On the National Drug List The authors find immunoglobulins 0.5 g/10 ml, 2.5 g/50 ml and 5 g/100...