Community acquired pneumonia: CAP Janković, Jelena; Jandrić, Aleksandar; Jordanova, Elena
Halo 194,
2022, Letnik:
28, Številka:
3
Journal Article
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Introduction: Pneumonia is one of the most common diseases in modern medicine. It is an inflammation of the lung parenchyma caused by various agents or noxae. It is present equally in both sexes but ...does occur more commonly in people who are older, immunocompromised or have comorbidities (COPD, heart or kidney diseases). The most common causing microorganisms are Streptococcus pneumoniae, Haemophilus influenzea, Moraxella catarrhalis and Mycoplasma pneumoniae. Treatment decisions are based on physical examination results, lab analyses, sputum analysis, CURB65 and PSI scores. The patient is then treated as an in-patient or an out-patient. Treatment can be pharmacological or non-pharmacological. Patients are treated pharmacologically with combined antibiotic therapy according to antibiogram results or, more commonly, empirically. Since a high mortality rate from pneumonia persists worldwide, adequate and timely treatment of these patients is of the utmost importance.
Introduction: The study aimed to assert the relationship between central corneal thickness (CCT) and intraocular pressure (IOP) measured by: Goldmann applanation tonometry (GAT) and Dynamic contour ...tonometry (DCT). Materials and Methods: The study included 150 patients with a mean age of 59.39 ± 13.12 years. Patients were divided into three groups: 50 primary open-angle glaucoma (POAG) patients, 50 ocular hypertension (OHT) patients, and 50 normal tension glaucoma (NTG) patients. IOP was determined using GAT and DCT. CCT was measured by ultrasound pachymetry. Results: IOP measured with DCT was higher than IOP measured with GAT (19.80 ± 3.67 mmHg vs 17.71 ± 3.35 mmHg). A significant positive association between IOP measured with GAT and IOP measured with DCT was found in all patients (r = 0.867, p < 0.01). A significantly positive association between IOP measured with GAT and IOP measured with DCT in POAG (r = 0.855, p <0.01), OHT (r = 0.826, p < 0.01), and NTG patients (r = 0.832, p < 0.01) were found. A significant positive correlation between CCT and IOP measured with GAT (r = 0.198, p < 0.01), as well as a significant positive correlation between CCT and IOP measured with DCT was found (r = 0.198, p < 0.01) in all patients. There was no correlation between CCT and IOP measured neither with GAT nor with DCT separately in three patient groups (p > 0.05). Conclusion: CCT-influenced IOP was measured by both methods, GAT and DCT. DCT can not replace GAT, but it is very useful, especially in cases where errors are in the IOP GAT measurement.
Introduction: In the kidney, cells in the thick ascending limb of the loop of the Henle synthesized uromodulin (UMOD). This study aims to present the evaluation of the uromodulin serum concentration ...in diabetes mellitus type 2 (T2DM) patients in the early detection of kidney damage. Materials and methods: The study included 50 T2DM patients mean age of 60.75 ± 11.23 years estimated glomerular filtration rate (eGFR) 114.38 ± 22.12 ml/min and a control group of 20 healthy persons. We measured serum concentration of haemoglobin, urea, creatinine, uromodulin (ELISA method), and cystatin C (nephelometry). We determined formulas: Cockcroft-Gault# (combination Cockcroft-Gault for patients with BMI < 30 kg/m2 and Cockcroft-GaultLBW for patients with BMI ≥ 30 kg/m2), CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration equation), and simple Cystatin C. Results: T2DM patients had lower hemoglobin serum concentration as well as eGFR calculated by formulas: Cockcroft-Gault# and CKD-EPI. T2DM patients had significantly higher BMI and cystatin C compared to control group. T2DM patients had significantly lower serum uromodulin concentration (136.51 ± 84.34 vs 220.50 ± 92.39 ng/ml) than in controls. Significant positive correlation between uromodulin and Cockcroft-Gault# (r = 0.432, p = 0.000), CKD-EPI (r = 0.439; p = 0.000) formulas as well as simple cystatin C (r = 0.250, p = 0.02), but negative correlation with age (r = -0.476, p = 0.000), BMI (r = -0.313, p = 0.002) and cystatin C serum concentration (r = -0.293, p = 0.015) were found. Conclusion: The role of serum uromodulin concentration is not still fortified. The results of this study showed that reduced uromodulin serum concentration indicated early kidney damage in T2DM patients.
Background/Aim. Different surgical interventions have been proposed, including trabeculectomy associated with antiproliferative agents because silicone oil (SO) removal cannot necessarily provide ...intraocular pressure (IOP) control. The aim of the study was to determine the efficacy of trabeculectomy with mitomycin C (MMC) for lowering IOP in patients with open-angle glaucoma (OAG) secondary to emulsified SO after pars plana vitrectomy. Methods. A single-center, prospective study was conducted, from December 2014 to December 2019, on 56 consecutive patients with an uncontrolled elevation of IOP after SO removal who were subjected to trabeculectomy with mitomycin MMC in that period. The primary end-point was the IOP at the three-year follow-up visit. Complete surgical success was defined as an IOP ranging from 7 mmHg to 18 mmHg without glaucoma medication. Qualified success was defined a s I OP ? 2 1 m mHg with one or two topical medications. Results. Fifty-six patients with a mean age of 5 3.6 standard deviation (SD)15.5 years had a mean baseline IOP of 42.3 (39.3 to 45.3) mmHg, which reduced to 18.6 (17.9 to 19.3) mmHg three years after surgery (p < 0.0001). Seventeen (30.4%) eyes were classified as a complete success, 21 (37,5%) as a qualified success, and 18 (32.1%) as a failure. In all successfully treated patients, the number of antiglaucoma medications was significantly reduced from 2.85 (SD 0.77) to 1.63 (SD 0.62), p < 0.0001. Conclusion. Trabeculectomy with MMC may be an option for lowering IOP in patients with OAG secondary to emulsified SO after pars plana vitrectomy, which was not controlled with maximum
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
Fractal dimension is an indirect indicator of signal complexity. The aim was to evaluate the fractal and textural analysis parameters of glomeruli in obese and non-obese patients with ...glomerular diseases and association of these parameters with clinical features.
Methods
The study included 125 patients mean age 46 ± 15.2 years: obese (BMI ≥ 27 kg/m2—63 patients) and non-obese (BMI < 27 kg/m2—62 patients). Serum concentration of creatinine, protein, albumin, cholesterol, trygliceride, and daily proteinuria were measured. Formula Chronic Kidney Disease Epidemiology Colaboration (CKD-EPI) equation was calculated. Fractal (fractal dimension, lacunarity) and textural (angular second moment (ASM), textural correlation (COR), inverse difference moment (IDM), textural contrast (CON), variance) analysis parameters were compared between two groups.
Results
Obese patients had higher mean value of variance (t = 1.867), ASM (t = 1.532) and CON (t = 0.394) but without significant difference (P > 0.05) compared to non-obese. Mean value of COR (t = 0.108) and IDM (t = 0.185) were almost the same in two patient groups. Obese patients had higher value of lacunarity (t = 0.499) in comparison with non-obese, the mean value of fractal dimension (t = 0.225) was almost the same in two groups. Significantly positive association between variance and creatinine concentration (r = 0.499, P < 0.01), significantly negative association between variance and CKD-EPI (r = -0.448, P < 0.01), variance and sex (r = -0.339, P < 0.05) were found.
Conclusions
Variance showed significant correlation with serum creatinine concentration, CKD-EPI and sex. CON and IDM were significantly related to sex. Fractal and textural analysis parameters of glomeruli could become a supplement to histopathologic analysis of kidney tissue.
•Variance showed significant correlation with eGFR calculated by CKD- EPI formula.•Significant correlation between variance and serum creatinine was found.•Textural contrast and inverse difference moment were significantly related to sex.•Fractal analysis of glomeruli could become supplement to histopathologic analysis.•Textural analyses of kidney tissue should become useful to histopathologic analysis.
Introduction/Objective Postmortem examination has a significant role in evaluating the quality of health care. The objective of the paper is to analyze the cause of death as determined by postmortem ...examination in patients who had undergone emergency hospitalization and had subsequently died within 24h, as well as the factors that contributed to the fatal outcome and correlation with available clinical data. Methods the analysis included autopsy reports and protocols, as well as clinical data from medical records and autopsy referrals during the three year period (2018-2020) for patients who had undergone a postmortem examination at the Insitute of Pathology, Medical Faculty, University of Belgrade. The correlation between the clinical diagnosis and postmortem findings was evaluated using Goldman criteria. Results the patients analysed were predominantly male (52/90; 58%). Women were statistically significantly older than men (p=0.024). The most common clinical diagnosis was cardiovascular disease (32.2%). The majority of the patients reported experiencing the first symptoms a few hours before seeking medical help (80%). The majority of the patients were being treated for chronic disease (80%) before hospitalization. The immediate cause of death determined by postmortem examination was most commonly heart failure (38/90, 42.2%). The most common clinically unrecognised causes of death include: bronchopneumonia (8/90), myocarditis (3/90), acute ischemic lesion/acute myocardial infarction (3/90) and bowel infarction (3/90). Conclusion the correlation between clinical and postmortem findings is very important because it enables the discovery of diagnostic and treatment errors and promotes new knowledge crucial for medical advancement.
Bronchiectasis is a chronic lung disease characterized by an abnormal dilation of the bronchial lumen caused by weakening or destruction of the muscle or elastic components of the bronchial wall, ...decreased mucous clearance and frequent infections of the respiratory tract. The golden standard for bronchiectasis diagnosis is high-resolution computed tomography (HRCT) of the chest. Inflammation holds a central role in the development of structural lung changes, as well as airway and lung parenchyma damage. Infection and colonization of the respiratory tract contribute to increased inflammation and further damage to the lung. Upon entry into the respiratory tract, the pathogens activate epithelial cells, macrophages and dendritic cells. Activated inflammatory cells secrete chemical mediators which activate the immune response and thus allow the phagocytosis of pathogens. Early diagnosis, appropriate treatment and interruption of the vicious circle between infection and inflammation in patients suffering from bronchiectasis, prevent the development of structural changes to the airways.
Background/Aim. In the past three decades focal segmental glomerulosclerosis
(FSGS) was commonly regarded as a part of obesity related glomerulopathy
(ORG) a distinct entity featuring proteinuria, ...glomerulomegalia, progressive
glomerulosclerosis and renal functional decline. The aims of the present
study were to evaluate the glomerular morphometry, clinical features and two
years outcome in obese and non-obese FSGS patients. Methods. The study
included 35 FSGS patients (23 males, age 46.5?15.2 years); divided in two
groups: obese (BMI ?27 kg/m2- 18 patients, age 47.2?15.5 years) and
non-obese (BMI <27 kg/m2- 17 patients, age 45.7?15.2 years). The serum
concentrations of proteins, albumin, cholesterol, triglyceride and
creatinine were determined at the time the biopsy, 6, 12, 24 months after
the biopsy. Formulas Cockcroft- Gault (BMI <27 kg/m2) and
Cockcroft-GaultLBW(BMI ?27 kg/m2) were calculated. Glomerular radius (GR),
glomerular volume (GV) and glomerular density (GD) were compared
morphometrically between two groups. Results. At the time of kidney biopsy
and 6 months later the obese had significantly lower GFR compared to
non-obese. After 24 months follow-up there wasn?t any difference between
groups. Obese had significantly higher GR (109.44?6,03 ?m vs 98.53?14,38 ?m)
and GV (3.13?0.49 x106 ?m3 vs 2.26?0.83 x106 ?m3),only midly lower GD
(1.91?0.39/mm2 vs 1.95?0.61/mm2) compared to non-obese. Significant positive
association between GV and BMI (r=0.439) was found. After 12 months
follow-up significantly higher percentage of non-obese patients reached
complete remission (71.4% vs 37.5%) compared to obese (?2=0.041), but after
24 months there were no significant difference. Conclusion. Obese patients
at the time of kidney biopsy and 6 months later had already the significant
lower kidney function compared to non-obese. However, after 12 and 24
months, this difference was still lower and without significance as well as
after 24 months percentage of patients with complete remission between two
groups.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Introduction Dynamic contour tonometry (DCT) is a contact, non-applanation method for measuring intraocular pressure (IOP). Objektive The study aimed at evaluating the impact of central corneal ...thickness (CCT) on values of IOP measured using two methods: Goldmann applanation tonometry (GAT) and DCT. Methods The study included 150 patients (300 eyes) with the diagnosis of open-angle glaucoma (54 males) and mean age of 59.39± 13.12 years. IOP was measured using two methods: GAT and DCT. CCT was measured (ultrasound pachymetry). DCT introduced a new value - the ocular pulse amplitude (OPA). Results The IOP measured with the GAT was lower compared to the IOP measured with DCT (17.71±3.35mmHg vs 19.80± 3.67mmHg). There was a significant positive correlation between IOP measured with GAT and IOP measured with DCT (r= 0.867, p< 0.01). In all patients, there was a significant positive correlation between CCT and IOP measured with GAT (r=0.198, p< 0.01), as well as between CCT and IOP measured with DCT (r=0.180, p< 0.05). With every 10mm of change in CCT, the change of IOP measured with GAT was 0.3mmHg, while the average change of IOP measured with DCT was 0.4 mmHg. There was a significant positive correlation between CCT and OPA (r=0.204, p< 0.01). There was also a significant positive correlation between OPA and IOP measured with GAT (r= 0.393, p< 0.01) and between OPA and IOP measured with DCT (r= 0.452, p< 0.01). Conclusion IOP measured with GAT was lower than IOP measured with DCT. CCT had impact on both methods: GAT and DCT. The impact of CCT on IOP (DCT) was lower compared to the impact of CCT on IOP(GAT).
Introduction/aim Clinical signs and symptoms of pulmonary embolism (PE) are non-specific, which is why it is commonly not diagnosed on time or sometimes not diagnosed at all. We are presenting a case ...of pulmonary embolism manifesting with syncope as a dominant symptom. Case report A 74-year-old female patient was hospitalized at the Clinic for Pulmonary Diseases with PE manifested with syncope. At admission, she was afebrile, tachypneic, with normal cardiac function and normal blood tension. Upon auscultation, breathing was muffled with late inspiration crackles above the base of the left lung. There were no other significant findings. The chest X-ray recorded at admission showed a non-homogenous shadow towards the base of the left lung and minimal pleural effusion. The ECG and echocardiography findings were normal. Partial respiratory insufficiency was verified by the acid-base balance analysis. Inflammatory markers were significantly elevated, with erythrocyte sedimentation rate of 30mm/h, fibrinogen of 8.62g/l and D-dimer of 18.6mg/l. Anticardiolipin IgG and IgM antibodies were negative, as well as beta-2 GPI IgG and IgM antibodies. An MDCT lung angiography was performed because of the elevated values of D-dimer and tachypnea, which showed multiple emboli of various sizes in the distal part of the right pulmonary artery and all lobar branches, as well as an embolus in the lobar branch for the lower lobe of the left lung. After a neurology consult, a head CT was ordered because the patient had suffered from loss of consciousness, but there were no pathological densities in the brain. Colour Doppler Ultrasonography of the blood vessels in the lower extremities showed organized thrombosis of the left femoral vein. A vascular surgeon was consulted and he prescribed anticoagulant therapy and an elastic compressive stocking, with control Colour Doppler Ultrasonography to be performed in six months. Conclusion Although syncope is an easily detectable symptom, it is still an unregulated crossroad of many an internal and neurological disease.
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