With the stable gastric pentadecapeptide BPC 157 therapy known to heal various both external and internal rat fistulas, we attempt to approach vesicovaginal fistula, continuous urine leaking through ...vagina, bladder stones, and a possible therapy solution among rats with well-formed 2 week-fistulas (vaginal/vesical 4 mm large defects) started with delayed therapy. Subsequent control fistula course (the subsequent 1, 2, 4, and 6 weeks) since beginning revealed the failed healing, fistula leaking, adhesions, urinary leaking through vagina, failed epithelization, collagenization, granulation tissue and neovascularization, increased inflammation, and necrosis. Thereby, the later intervals revealed the persistent inability to sustain even minimal volume, vesical, and vaginal defects and stone formation at the end of the experiment (fistula-time day 56). BPC 157 therapy (10 µg/kg, 10 ng/kg, intraperitoneally once time daily or perorally in drinking water until sacrifice) was initiated with a considerable delay (at 2 weeks after fistula formation). Already within 1 week therapy, all BPC 157 regimens stopped urinary leaking through vagina, reversed the otherwise resistant poor healing course to the increased epithelization, collagenization, granulation tissue and neovascularization, decreased inflammation, and decreased necrosis. Thereby, at later intervals, all BPC 157 rats exhibited a five times larger volume that can be sustained before leaking as in healthy, vesical, and vaginal defects completely closed and no stone formation. Thus, macro/microscopic and functional recovery, and counteracted stone formation. Concluding, BPC 157 therapy’s beneficial effects resulted in healing and no stone formation, with µg- and ng-regimens, either given daily perorally in drinking water or intraperitoneally.
Out-of-hospital cardiac arrest (OHCA) remains a global healthcare problem, with low survival and bystander cardiopulmonary resuscitation (CPR) rates. This study aimed to identify event-related ...factors in OHCA and their impact on return of spontaneous circulation (ROSC) achievement and maintenance until hospital admission.
All data were collected from Utstein Resuscitation Registry Template for OHCA from The Institute of Emergency Medicine of Zagreb from January 2012 to August 2022. This cross-sectional research analyzed 2839 Utstein reports, including 2001 male, 836 female, and 8 subjects of unknown gender. The average age was 65.4 ± 16.2 years.
The most frequent place of collapse was private residence, and 27% of collapses were unwitnessed. Dispatcher-provided CPR instructions were provided in 39.7% of cases until the arrival of the emergency service team, which showed a very strong effect on bystander-provided CPR, and were followed in 68.4% of cases, while non-instructed bystander CPR was provided in only 7.9% of cases. Bystander CPR is more likely to be provided in public places than in private residences, often with both compression and ventilation. Bystander CPR was also more likely to be provided to men. Cases with bystander CPR, and compressions with ventilation compared to compression only CPR, showed a significantly greater success in maintaining ROSC later in CPR, both with moderate effects.
Bystander CPR has been shown to have a significant role in achieving and maintaining ROSC until hospital admission. However, our results showed a location-dependent nature of bystanders' willingness to perform CPR as well as sex disparities in patients receiving CPR. With deficient education in basic life support in Croatia, dispatchers need to insist on and instruct bystander CPR performance.
Anterior rectal resection is a standard surgical procedure for treating carcinomas of rectum and distal sigmoid colon. In many cases of anterior rectal resection, postoperatively some level of fecal ...incontinence may occur. The aim of our study was to evaluate the impact of the colorectal anastomosis level on anorectal functional disorder. In our prospective study, the participants were patients diagnosed with carcinoma of rectum or distal sigmoid colon. All patients underwent standard open or laparoscopic anterior rectal resection. Six months after the surgery, the function of anorectum was evaluated in all participants. Finally, 38 patients were analyzed, including 13/38 (34.2%) patients with high rectal anastomosis, 11/38 (28.9%) with mid rectal anastomosis and 14/38 (36.8%) with low rectal anastomosis. Patients with a lower level of anastomosis had a statistically significantly greater number of stools, higher urgency and discrimination impairment, more pronounced solid, liquid and gas incontinence, and greater need for diapers (p<0.05 all). Therefore, patients with lower anastomosis had a statistically significant impairment of their quality of life and higher Wexner score (p<0.001 for both analyses). Our study results suggested reduced neorectal capacity to be the main pathophysiological factor for the development of postoperative anorectal function impairment.
Anterior rectal resection is a standard surgical procedure for treating carcinomas of rectum and distal sigmoid colon. In many cases of anterior rectal resection, postoperatively some level of fecal ...incontinence may occur. The aim of our study was to evaluate the impact of the colorectal anastomosis level on anorectal functional disorder. In our prospective study, the participants were patients diagnosed with carcinoma of rectum or distal sigmoid colon. All patients underwent standard open or laparoscopic anterior rectal resection. Six months after the surgery, the function of anorectum was evaluated in all participants. Finally, 38 patients were analyzed, including 13/38 (34.2%) patients with high rectal anastomosis, 11/38 (28.9%) with mid rectal anastomosis and 14/38 (36.8%) with low rectal anastomosis. Patients with a lower level of anastomosis had a statistically significantly greater number of stools, higher urgency and discrimination impairment, more pronounced solid, liquid and gas incontinence, and greater need for diapers (p<0.05 all). Therefore, patients with lower anastomosis had a statistically significant impairment of their quality of life and higher Wexner score (p<0.001 for both analyses). Our study results suggested reduced neorectal capacity to be the main pathophysiological factor for the development of postoperative anorectal function impairment. Key words: Anterior resection; Rectal cancer; Wexner incontinence score; Anorectal junction Anteriorna resekcija rektuma je standardni operacijski zahvat kod lijecenja karcinoma rektuma i distalnog dijela sigmoidnog kolona. U mnogim slucajevima anteriorne resekcije poslijeoperacijski se pojavljuje odredena razina fekalne inkontinencije. Cilj nase studije bio je istraziti utjecaj visine kolorektalne anastomoze na funkcijski poremecaj anorektuma. Svi ispitanici su podvrgnuti standardnoj otvorenoj ili laparoskopskoj anteriornoj resekciji. Sest mjeseci nakon operacije funkcija anorektuma je evaluirana. Ukupno je analizirano 38 bolesnika, tj. 13/38 (34,2%) s visokom kolorektalnom anastomozom, 11/38 (28,9%) sa srednjom kolorektalnom anastomozom i 14/38 (36,8%) s niskom kolorektalnom anastomozom. Bolesnici s nize postavljenom anastomozom imali su statisticki znacajno veci broj stolica, cesce su imali urgenciju i poremecaj diskriminacije, kao i jace izrazenu krutu, tekucu i inkontinenciju plinova, cesce su trebali pelene (p<0,05 za sve navedene analize). Sukladno tome, bolesnici s nize postavljenom anastomozom imali su statisticki znacajno jace narusenu kvalitetu zivota i visi Wexnerov zbir (p<0,001 za obje analize). Misljenja smo da je smanjeni kapacitet neorektuma glavni patofizioloski cimbenik za razvoj poslijeoperacijskog funkcijskog poremecaja anorektuma. Kljucne rijeci: Anteriorna resekcija; Karcinom rektuma; Wexnerov bodovni sustav; Funkcija anorektuma
Objective: Poor adherence is the main reason for inadequate blood pressure control. Pharmacists are highly accessible healthcare professionals, and it has been reported that community pharmacist-led ...interventions improved patients’ BP control and outcomes. Some authors reported on the beneficial effects of mobile applications on better drug adherence. The aim of this study was to identify subjects in the general population who may benefit from such interventions. Design and method: A total of 1228 subjects enrolled in the EHUH 2 study (a random sample, nationwide survey) and 424 participants of the Hunt on the Silent Killer (HSK) (opportunistic screening on islands) were included in this analyses. The same questionnaire was applied containing questions about health issues, therapy, habits, and opinion on pharmacists’ and mobile applications’ (MA) role in hypertension treatment. Results: The binomial logistic regression analysis showed a significant model when comparing positive and negative answers for the following: the participants were more likely to be in favour of pharmacists’ role if they had a positive history of angina pectoris ( = 1.333, p = 0.016), diabetes mellitus ( = 1.125, p < 0.001), dyslipidemia ( = 1.326, p < 0.001), or being treated for hypertension ( = 1.326, p < 0.001) in the HSK, and in the EHUH 2 study if they suffered a stroke (100%). Socio-demographic factors had no impact on the pharmacists’ role in the general population. However, at islands significantly enhanced negative responses in case of lower household income (35%), married state (29%) and employed subjects (17%) were observed. The participants were more likely to be in favour of MA if they had a positive history of hypertension, have higher income and were married. Interestingly, the history of cardiovascular diseases indicated more negative responses. Conclusions: The participants were generally in favour of MA, which may confirm the need to digitalise the healthcare system, but it was more enhanced in participants with a higher socio-demographic status. Pharmacists-led interventions (lifestyle support and adherence increasing programs) have to be individualized.
Objective. Diagnosing acute appendicitis (AA) is challenging and this has stimulated surgeons to develop scoring systems that could potentially decrease the rate of misdiagnosis in patients with ...suspected appendicitis. One of the most widely used today is the Modified Alvarado scoring system (MASS), however its sensitivity and specificity varies a great deal between studies. As a result, we wanted to assess the diagnostic accuracy of MASS retrospectively at our institution to achieve the highest possible value of sensitivity and decrease the number of false negative patients.Material and Methods. We retrospectively calculated MASS for all subsequent patients who had undergone an appendectomy at our institution between July 2015 and March 2017.Results. In 118 out of 146 operated patients, AA was confirmed intraoperatively. There was a statistically significant difference between the average MASS score in the positive and negative appendectomy groups (6 v. 4, respectively, P<0.001), with a significantly higher number of females among the negative appendectomies (P<0.001). When lowering the cut-off to a value as low as ≥3, the sensitivity of the MASS score increased to 97.45% (95% CI: 92.7 – 99.5), thus obtaining a very low false negative rate of merely 2.55%.Conclusion. This retrospective diagnostic accuracy study confirmed the higher average MASS score in the group of patients with confirmed AA diagnosis. A MASS score above the proposed low cut-off value (≥3) can be a useful tool to help surgeons ruling in patients with AA in order to reduce the risk of missing diagnosis.
Surgical site infections (SSI) are defined as infections that occur 30 days after surgery. They are among the most common healthcare-associated infections. The aim of our study was to evaluate ...antimicrobial efficiency of Triclosan coated Polyglactin 910 suture in our patients with colorectal cancer. In our prospective study participants were patients of our surgical departement which underwent colon resection for diagnosed colorectal cancer. For abdominal closure in half of patients Polyglactil 910 coated with triclosan was used and in the other half Polyglactil 910 without triclosan. The occurrence of SSI among groups were observed. Aswell, duration of hospitalization, early postoperative leukocyte and CRP levels were observed. The mean hospitalization period was 11,7±1.2 day in the Triclosan group and 16.4±2.2 in the Non - triclosan group. In both groups lekocyte and CRP levels were similary elevated on 2nd and 5th postoperative day. Higher average leukocyte and CRP levels were found in first group on 7th and 10th postopetaive day. Significantly less SSIs were seen in Triclosan group compared with the Non - triclosan group (10,81% vs 22,2%). SSIs areassociated with longer post-operative hospital stays, may necessitate additional surgical procedures, may require intensive care, and result in higher attributable morbidity and mortality Our study confirmed that patients in which abdominal wall was closed with triclosan coated suture had much better results, less incidence of SSI, shorter hospitalization time and better cost effectiveness.
Diagnosing acute appendicitis (AA) is challenging and this has stimulated surgeons to develop scoring systems that could potentially decrease the rate of misdiagnosis in patients with suspected ...appendicitis. One of the most widely used today is the Modified Alvarado scoring system (MASS), however its sensitivity and specificity varies a great deal between studies. As a result, we wanted to assess the diagnostic accuracy of MASS retrospectively at our institution to achieve the highest possible value of sensitivity and decrease the number of false negative patients.
We retrospectively calculated MASS for all subsequent patients who had undergone an appendectomy at our institution between July 2015 and March 2017.
In 118 out of 146 operated patients, AA was confirmed intraoperatively. There was a statistically significant difference between the average MASS score in the positive and negative appendectomy groups (6 v. 4, respectively, P<0.001), with a significantly higher number of females among the negative appendectomies (P<0.001). When lowering the cut-off to a value as low as ≥3, the sensitivity of the MASS score increased to 97.45% (95% CI: 92.7 - 99.5), thus obtaining a very low false negative rate of merely 2.55%.
This retrospective diagnostic accuracy study confirmed the higher average MASS score in the group of patients with confirmed AA diagnosis. A MASS score above the proposed low cut-off value (≥3) can be a useful tool to help surgeons ruling in patients with AA in order to reduce the risk of missing diagnosis.
Colorectal cancer is the most common malignant tumor of the digestive system with an incidence of about 40/100 000. Large bowel resections are extensive and are followed by numerous potential ...postoperative complications such as SSI (surgical site infection), dehiscence of anastomosis or paralytic ileus. Numerous studies have shown that the patients’ nutritional status correlates with the incidence of complications. By introducing the ERAS protocol (enhanced recovery after surgery), the nutritional status of the patient is improved and the risks of complications are reduced. The aim of our study is to examine the importance of using ERAS protocol in patients with colorectal cancer. In a period of 6 months, we included 51 patients from our clinic who went under elective colon resection with ERAS protocol (ERAS group). Incidence of complications and recovery rate were observed. As a control group, we included 57 patients from our clinic that were admitted for elective colon cancer surgery a year prior, but didn’t have perioperative nutritional support (non-ERAS group). The ERAS protocol patient group had significantly lower incidence of postoperative complications including SSI (11.75% versus 19.29%), dehiscence of anastomosis (1.9% vs 5.2%) and dehiscence of the abdominal wall (0 vs 3.5%), compared to the patients in the non-ERAS protocol group. They also had shorter hospitalization time (11.7 vs 14.2days). Perioperative nutritional support reduces the risk of complications in patients undergoing colon resection, accelerates recovery and returns the patient to his daily activities sooner, resulting in reduced treatment expenses.
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