The aim of this paper is to gather and evaluate available literature about using videolaryngoscopy as a training tool for novice learners and compare it to direct laryngoscopy. Search of the ...available literature was performed using the MEDLINE database, through the PubMed searching tool. The inclusion criteria were that papers had to be original research and participants had to be novices in the field of airway management. The studies also had to pertain to the topic of using videolaryngoscopy as a training tool, therefore all papers that evaluated performance of videolaryngoscopy in clinical applications or did not pertain to using videolaryngoscopy as a training tool were excluded from this review. Five studies were identified that fitted the inclusion criteria, all of which showed a statistically significant difference in first attempt success at endotracheal intubation in favor of videolaryngoscopy when compared to direct laryngoscopy. One of the studies also demonstrated a faster skill acquisition rate when using videolaryngoscopy. The use of videolaryngoscopy in teaching airway management to trainees (emergency medicine residents included) is a viable option and should be encouraged and researched further.
Spontaneous renal artery dissection (SRAD) is a rare clinical event which most commonly presents with nonspecific symptoms such as acute
flank pain, hypertension, fever, hematuria. It rarely occurs ...as an isolated, non-traumatic event and in those cases the underlying causes include atherosclerosis, fibromuscular dysplasia, collagen vascular disease and severe exertion. Only a few case reports suggest a possible connection between SRAD and antiphospholipid syndrome (APS).
Angioedema is a form of allergic mediated by histamine and non-allergic mediated by bradykinin and can be lethal if not recognized and treated promptly. This case demonstrates the proper diagnosis of ...and intervention in rapid onset severe angioedema. A 68-year-old male came to the emergency department with a complaint of dyspnea that started two hours before. He had type II diabetes, chronic kidney disease and several different antihypertensive medications, including an ACE inhibitor for hypertension. During physical examination, the patient was hypertensive, tachycardic, tachypnoic, and edematous. During his stay in the ED he was treated with a combination of corticosteroids, antihistamines and epinephrine, but the patient’s edema and dyspnea worsened and his oxygen saturation started to deteriorate with a progression of skin edema. Intubation was not possible due to the large edema of the tongue, so a tracheotomy was done. An ampule of icatibant was administered and rapid regression of the edema, along with the stabilization of the patient’s vital signs, followed after five minutes. The patient was discharged home after five days with a recommendation of discontinuing the ACE inhibitor. While non-hereditary angioedema is not a rare condition, emergency physicians should be adequately educated about it.
New-onset diabetes after transplantation (NODAT) is a frequent and severe complication after renal transplantation. It is diagnosed according to standard criteria for type 2 diabetes. Risk factors ...for NODAT are non-modifiable (non-white ethnicity, older age, genetic predisposition, previous glucose intolerance, steroid therapy, male donor, and others) and modifiable (obesity, viral infections, and immunosuppressive therapy). Glucose control is needed immediately after renal transplantation and after 3, 6, and 12 months and annual glucose control is needed after that period. When NODAT is diagnosed, the primary goal includes lifestyle modification, like a diet with weight loss and exercise, and obtaining optimal glucose control to reduce micro- and macrovascular complications of diabetes. In order to obtain better glucose control, modification of immunosuppressant therapy is also needed, like a reduction of corticosteroid and calcineurin inhibitors and also a conversion of tacrolimus to a less glucotoxic agent. Pharmacotherapy includes oral hypoglycemic agents (in most cases metformin, sulfonylureas, and dipeptidyl peptidase-4 (DPP-4) inhibitors) and insulin (in most cases biphasic insulin several times daily or intensive insulin therapy). Finally, metabolic risk factors like dyslipidemia and hypertension should also be treated, and a regular annual screening should be performed for micro- and macrovascular complications of diabetes. Key words: new-onset diabetes after transplantation (NODAT), immunosuppressive drugs, diabetes management, kidney
Chronic wounds are often underestimated condition with increasingly growing inpatient and outpatient treatment costs. Since the patient population affected by chronic wounds is heterogeneous and ...includes diabetes, chronic venous insufficiency and peripheral artery disease patients, with additional differences in gender, age, previous medical history, treatment of chronic wounds is highly personalized and dependent on a variety of factors. This paper aims to highlight the problems that the chronic wound patient population is facing during the COVID-19 pandemic: from higher probability of an undesirable disease outcome to the fact that many of them have limited access to primary care providers and to the regular and continuous care that their condition demands. This paper describe three patients with chronic wounds. Each of the patients had a significant worsening of their chronic wounds during the COVID-19 pandemic: either following an active SARS-CoV-2 infection or due to the limited access to primary care. The cases described here highlight the necessity of providing proper and regular care for all patients during the COVID-19 pandemic, regardless of the current state of the healthcare system and the adversities and hurdles it currently faces, to prevent the pandemic from becoming a syndemic.
Cardiorenal syndrome (CRS), first defined in 2004 as a consequence of the interactions between the kidneys and other circulatory departments leading to acute heart failure, has since been recognized ...as a complex clinical entity that is hard to define, diagnose and classify. The framework for the classification of CRS according to pathophysiologic background was laid out in 2008, dividing CRS into five distinct phenotypes. However, determining the timing of individual organ injuries and making a diagnosis of either renal or cardiac failure remains an elusive task. In clinical practice, the diagnosis and phenotyping of CRS is mostly based on using laboratory biomarkers in order to directly or indirectly estimate the degree of end-organ functional decline. Therefore, a well-educated clinician should be aware of the effects that the reduction of renal and cardiac function has on the diagnostic and predictive value and properties of the most commonly used biomarkers (
troponins, N-terminal pro-brain natriuretic peptide, serum creatinine
). They should also be acquainted, on a basic level, with emerging biomarkers that are specific to either the degree of glomerular integrity (cystatin C) or tubular injury (neutrophil gelatinase-associated lipocalin). This narrative review aims to provide a scoping overview of the different roles that biomarkers play in both the diagnosis of CRS and the prognosis of the disease in patients who have been diagnosed with it, along with highlighting the most important pitfalls in their interpretation in the context of impaired renal and/or cardiac function.
Liver cirrhosis is an increasing public health problem and a major cause of morbidity and mortality. Accordingly, cirrhotic cardiomyopathy, a frequently underdiagnosed condition, is becoming a ...growing health problem. In the last 20 years, cardioselective biomarkers have been investigated for their diagnostic and prognostic properties for numerous conditions. The aim of this article is to review the literature on the relationship between the most commonly used cardioselective biomarkers (cardiac troponins I and T, N-terminal pro-B-type natriuretic peptide, brain natriuretic peptide, and heart-type fatty-acid binding protein) and the presence, functional stage, and clinical outcomes of liver cirrhosis. Elevated plasma levels of these biomarkers have been reported in patients with liver cirrhosis, and there is mounting evidence on their predictive value for clinical outcomes in this disease. In addition, elevated plasma levels of these biomarkers have been reported in patients before, during, and after liver transplantation, but in fewer studies. Due to their predictive value for clinical outcomes, we advocate the use of these markers in patients with liver cirrhosis and cirrhotic cardiomyopathy, as well as in candidates for liver transplant.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
: It has recently been shown that cardiac-specific troponin I concentrations in first morning urine samples can be measured with commercially available tests. Due to their accumulation in the first ...morning urine, scientific papers indicate a potential predictive value for cardiovascular diseases. Therefore, the aim of this study was to compare the concentration of cardiac troponin I in the first morning urine in patients with severe aortic stenosis and the healthy population.
: Blood and first morning urine samples were collected from 34 healthy individuals (17 female) at University Hospital Merkur and 25 patients with severe aortic stenosis (14 female) before surgical treatment at University Hospital Dubrava. Cardiac troponin I and T values were determined using high-sensitivity assays using commercially available Abbott and Roche tests.
: Patients with severe aortic stenosis had significantly lower troponin I concentrations in the first morning urine samples (0.3 ng/L (0.1-0.6)) as compared to the healthy population (15.2 ng/L (8.4-19.9)) (
< 0.001). There was no statistically significant difference in troponin T concentrations between healthy individuals and patients with severe aortic stenosis. In parallel, both I and T plasma troponin concentrations were significantly higher in patients with severe aortic stenosis.
: In patients with severe aortic stenosis, cardiac troponin I values in the first morning urine are significantly lower than in healthy subjects.
Both hypothyroidism and hyperthyroidism affect renal function. The aim of this study was to investigate the relationship between parameters of thyroid function (TSH, free triiodothyronine (FT3), and ...free thyroxine (FT4)) and parameters of renal function in patients with type 1 diabetes (T1DM).The study included 272 T1DM with normoalbuminuria and estimated glomerular filtration rate (eGFR) > 60 ml/min.sup.-11.73m- (2), normal thyroid function, and without antihypertensive and antihyperlipidemic therapy. TSH significantly correlated with urinary albumin excretion rate (UAE) (r=-0.15, p<0.05) and fT3 with serum creatinine (r=0.12, p<0.05). Furthermore, fT4 significantly correlated with all renal function parameters (serum creatinine, eGFR and UAE (r=-0.12, 0.34 and -0.13, respectively, for all p<0.05)). Patients in the highest quartile of fT4 had significantly higher eGFR levels compared to those in the lowest quartile (116 vs. 101 ml/min.sup.-11.73m- (2), p<0.001). In logistic regression analysis, after adjustment for covariates, fT3 and fT4 were significantly associated with worsening of renal function parameters with odds ratios of 0.75 to 1.29. This study, conducted in euthyroid T1DM with normoalbuminuria and eGFR > 60 ml/min.sup.-11.73m- (2) without therapeutic intervention, suggests that the thyroid function may be connected with renal function parameters even in the euthyroid range. Key words: thyroid hormones, type 1 diabetes, renal function, albuminuria
Objectives
Diabetes mellitus is a group of metabolic disorders associated with high risk for cardiovascular disease. Although troponins are primarily clinically used for the diagnosis of acute ...coronary syndrome, they are also used in risk assessment in patients with acute coronary syndrome as well as in a number of other conditions. The aim of this review was to investigate the relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events.
Methods
Hemoglobin A1
c
has been chosen as the best clinical indicator of glucose control and risk of micro and macrovascular complications. We investigated cardiac troponins as a group of markers of muscle injury which includes troponin T, troponin I and troponin C. Troponin T and I are specific for myocardial injury, compared to C which is specific for skeletal muscle.
Results
In this review, we showed that there was a causal relation between hemoglobin A1
c
levels and serum troponin concentrations. Hemoglobin A1
c
has shown to be a positive predictive factor of incidence, mortality and morbidity of conditions such as acute coronary syndrome, arrhythmias, stroke, pulmonary embolism and other conditions that causes troponin elevation by its release in circulation.
Conclusions
Chronic hyperglycemia decreases glomerular filtration and consequently decreases troponin elimination and also by affecting the heart microcirculation it leads to microvascular damage and consequently to ischemia which contribute to troponin concentration elevation. Furthermore, correlation between hemoglobin A1
c
and troponin concentration manifests in their prognostic value for mortality.
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