In 10% to 30% cancer-pain cases standard analgesic therapy fails to provide effective pain relief. Interventional techniques, such as peripheral nerve blocks, neuraxial analgesia along with ...neurolytic blocks may be used for such refractory pain. Peripheral nerve blocks can be used when pain occurs in the territory of one or more peripheral nerves, but rarely as main therapy. Neuraxial analgesia is a valid option for progressive cancer pain, and healthcare possibilities and costs call into question the utility of intrathecal infusion pumps. Neurolysis is the targeted destruction of a nerve or nerve plexus, using chemicals, radiofrequency ablation (RFA), cryoablation, and neurosurgical procedures; however, it rarely completely eliminates pain because patients frequently experience coexisting somatic and neuropathic pain as well. Complex conditions of palliative patients along with limited high-quality randomized controlled trials limit the use of interventional procedures. Even so, some cancer patients benefit from interventional procedures to achieve pain alleviation and consequently improve quality of life.
Tocilizumab is used in patients with severe COVID-19 pneumonia and high concentration of IL-6. We studied potential prognostic role of neutrophil and lymphocyte count regarding tocilizumab treatment.
...We enrolled 31 patients with severe COVID-19 pneumonia and higher serum IL-6 concentration. The samples were taken on the day of tocilizumab administration and five days later. We used ROC analysis to investigate the association between the analysed parameters and 30-day mortality in order to determine the best pre-treatment and post-treatment prognostic factor. Kaplan-Meier curves and log-rank test were used to present and to analyse the difference in survival.
Patients had a median age of 63 (55-67) years and were treated with a median tocilizumab dose of 800 mg. During the 30-day follow-up period, 17 patients died (30-day mortality 54%). Among pre-treatment variables, neutrophil count had the best prognostic accuracy (AUC 0.81, 95%CI: 0.65-0.96, P = 0.004), while neutrophil to lymphocyte ratio (NLR) had the highest accuracy among post-treatment variables in predicting 30-day mortality (AUC 0.94, 95%CI: 0.86-1.00, P < 0.001). Among post-treatment parameters, neutrophil count and NLR were equally good prognostic factors. Post-treatment NLR cut-off of 9.8 had the sensitivity of 81% and specificity of 93%. Patients with NLR ≥ 9.8 had the median survival of 7.0 (3-10) days
. median survival not reached in patients with NLR < 9.8 (P < 0.001).
Pre-treatment and post-treatment neutrophil count with post-treatment NLR may represent prognostic tools for patients with higher IL-6 concentration in severe COVID-19 pneumonia treated with tocilizumab.
Twenty common genetic variants have been associated with risk of developing colorectal cancer (CRC) in genome wide association studies to date. Since large differences between populations exist, ...generalisability of findings to any specific population needs to be confirmed.
The aim of this study was to perform an association study between risk variants: rs10795668, rs16892766, rs3802842 and rs4939827 and CRC risk in Croatian population.
An association study was performed on 320 colorectal cancer cases and 594 controls recruited in Croatia. We genotyped four variants previously associated with CRC: rs10795668, rs16892766, rs3802842 and rs4939827.
SMAD7 variant rs4939827 (18q21.1) was significantly associated with CRC risk in Croatian population. C allele was associated with a decreased risk, odds ratio (OR): 0.70 (95% CI: 0.57-0.85, P=3.5E-04). Compared to TT homozygotes, risk was reduced by 34% in heterozygotes (OR=0.66, 95% CI: 0.47-0.92) and by 52% in CC homozygotes (OR=0.48, 95% CI: 0.33-0.72).
Our results show association of rs4939827 with colorectal cancer risk in Croatian population. The higher strength of the association in comparison to other studies suggests population-specific environmental or genetic factors may be modifying the association. More studies are needed to further describe role of rs4939827 in CRC. Likely reason for failure of replication for other 3 loci is inadequate study power.
D-blade is a relatively new device in the field of videolaryngoscopy, designed for
airway management by enabling indirectoscopic glottic view. In our study, we investigated efficiency
of D-blade in ...comparison with direct Macintosh laryngoscope (gold standard). Fifty-two adult
patients with normal airway scheduled for elective surgery in general anesthesia were randomly assigned
in D-blade video or direct Macintosh group. In the first video group, patients were laryngo-scoped
and intubated by D-blade, and in the second group laryngoscopy and intubation were performed
by Macintosh laryngoscope. Glottic view was evaluated according to Cormack Lehane grading
system (C-L), while duration of intubation and easiness of intubation were evaluated according to
the intubation difficulty score (IDS). Additionally, hemodynamic parameters were recorded before
and after induction. There were no statistically significant between-group differences in time to intubation,
easiness of endotracheal tube insertion, C-L, and IDS. In comparison with direct Macintosh
laryngoscope, D-blade showed similar but still favorable characteristics. In our opinion, D-blade is a
useful device in airway management and should be used in daily anesthesiologist work.
Syphilis is a sexually transmitted, systemic disease caused by the spirochete bacterium Treponema pallidum. The most common mechanism of transmission is sexual intercourse. Although there are several ...hypotheses, the exact origin of the disease remains unknown. Newly published evidence suggests that the hypothesis supporting the theory of the American origin of the disease is the valid one. Among 1500 analyzed pathographies of composers and musicians, data on ten Anglo-American composers and jazz musicians having suffered from neurosyphilis (tertiary stage of the disease) were extracted for this report. In this group of Anglo-American composers and musicians, most of them died from progressive paralysis while still in the creative phase of life. Additionally, diagnoses of eleven other famous neurosyphilitic composers, as well as basic biographic data on ten less known composers that died from neurosyphilis-progressive paralysis are also briefly mentioned. In conclusion, neurosyphilis can cause serious neurological damage, as well as permanent disability or death, preventing further work and skill improvement.
Sifilis je spolno prenosiva, sistemska bolest uzrokovana spirohetnom bakterijom Treponema pallidum. Najčešći način prijenosa bolesti je spolni odnos. Iako ima više hipoteza, točno podrijetlo bolesti ...još je uvijek nepoznato. Nedavno objavljeni podaci pokazuju da je najvjerojatnije točna hipoteza koja podupire teoriju američkog podrijetla bolesti. Među 1500 analiziranih patografi ja skladatelja i glazbenika za ovaj prikaz izdvojeni su podaci o deset angloameričkih skladatelja i jazz glazbenika koji su bolovali od neurosifi lisa (tercijarni stadij bolesti). U analiziranoj skupini angloameričkih skladatelja i glazbenika većina ih je umrla od progresivne paralize dok su još uvijek bili u kreativnoj fazi života. Dodatno, ukratko su prikazane dijagnoze jedanaestorice drugih slavnih skladatelja neurosifi litičara te također osnovni biografski podaci desetorice manje poznatih skladatelja koji su umrli od neurosifi lisa odnosno progresivne paralize. U zaključku, neurosifi lis može uzrokovati značajno neurološko oštećenje, a u težim slučajevima također dovesti do trajnog invaliditeta ili smrti i time spriječiti daljnji rad i profesionalni razvoj.
In 10% to 30% cancer-pain cases standard analgesic therapy fails to provide effective pain relief. Interventional techniques, such as peripheral nerve blocks, neuraxial analgesia along with ...neurolytic blocks may be used for such refractory pain. Peripheral nerve blocks can be used when pain occurs in the territory of one or more peripheral nerves, but rarely as main therapy. Neuraxial analgesia is a valid option for progressive cancer pain, and healthcare possibilities and costs call into question the utility of intrathecal infusion pumps. Neurolysis is the targeted destruction of a nerve or nerve plexus, using chemicals, radiofrequency ablation (RFA), cryoablation, and neurosurgical procedures; however, it rarely completely eliminates pain because patients frequently experience coexisting somatic and neuropathic pain as well. Complex conditions of palliative patients along with limited high-quality randomized controlled trials limit the use of interventional procedures. Even so, some cancer patients benefit from interventional procedures to achieve pain alleviation and consequently improve quality of life. Keywords: palliative care; cancer pain; refractory pain; nerve block; spinal anesthesia; neurolysis U 10% do 30% slucajeva karcinomske boli standardna analgetska terapija ne pruza ucinkovito ublazavanje boli. Interventne tehnike, kao sto su blokovi perifernih zivaca, neuraksijalna analgezija zajedno s neurolitickim blokovima mogu se koristiti za takvu refraktornu bol. Blokada perifernih zivaca moze se koristiti kada se bol javlja u podrucju jednog ili vise perifernih zivaca, ali rijetko kao glavna terapija. Neuroaksijalna analgezija je valjana opcija za progresivnu karcinomsku bol, a mogucnosti zdravstvene skrbi i troskovi dovode u pitanje korisnost intratekalnih infuzijskih pumpi. Neuroliza je ciljano unistavanje zivca ili zivcanog pleksusa, koristenjem kemikalija, radiofrekventne ablacije (RFA), krioablacije i neurokirurskih zahvata, medutim rijetko u potpunosti eliminira bol jer pacijenti cesto dozivljavaju i somatsku i neuropatsku bol. Slozena stanja palijativnih bolesnika uz ogranicena visokokvalitetna randomizirana kontrolirana ispitivanja ogranicavaju koristenje intervencijskih postupaka. Unatoc tome, neki karcinomski pacijenti imaju koristi od intervencijskih postupaka za ublazavanje boli i posljedicno poboljsanje kvalitete zivota. Kljucne ripci:palijativna skrb; karcinomska bol; refraktorna bol; blok zivca; spinalna anestezija; neuroliza
D-blade je relativno nov uređaj na području videolaringoskopije koji omogućava isključivo indirektan prikaz glotisa. U našem istraživanju uspoređivali smo učinkovitost D-blade-a s direktnim ...Macintoshevim laringoskopom koji predstavlja zlatni standard. Pedeset dvoje bolesnika s normalnim dišnim putem, predviđeni za elektivnu kiruršku operaciju u općoj anesteziji, randomizirano su dodijeljeni u skupinu video D-blade ili direktnog Macintosha. U prvoj skupini bolesnici su bili
laringoskopirani i intubirani video D-blade-om, a u drugoj skupini su bili laringoskopirani i intubirani Macintoshevim laringoskopom. Za procjenu prikaza glotisa koristili smo klasifikaciju Cormack Lehane (C-L), dok smo trajanje intubacije i lakoću intubacije procjenjivali koristeći ljestvicu bodovanja težine intubacije (engl. intubation difficulty score, IDS). Hemodinamske parametre smo bilježili prije i nakon indukcije. Između dviju skupina nije bilo statistički značajne razlike u vremenu intubacije, lakoći uvođenja tubusa, klasifikaciji C-L i IDS-u. Prema rezultatima našega istraživanja zaključujemo da u usporedbi s Macintoshevim laringoskopom D-blade pokazuje povoljne karakteristike te bi mogao biti uveden u svakodnevni rad anesteziologa.
Background Twenty common genetic variants have been associated with risk of developing colorectal cancer (CRC) in genome wide association studies to date. Since large differences between populations ...exist, generalisability of findings to any specific population needs to be confirmed. Aim The aim of this study was to perform an association study between risk variants: rs10795668, rs16892766, rs3802842 and rs4939827 and CRC risk in Croatian population. Methods An association study was performed on 320 colorectal cancer cases and 594 controls recruited in Croatia. We genotyped four variants previously associated with CRC: rs10795668, rs16892766, rs3802842 and rs4939827. Results SMAD7 variant rs4939827 (18q21.1) was significantly associated with CRC risk in Croatian population. C allele was associated with a decreased risk, odds ratio (OR): 0.70 (95% CI: 0.57-0.85, P=3.5E-04). Compared to TT homozygotes, risk was reduced by 34% in heterozygotes (OR=0.66, 95% CI: 0.47-0.92) and by 52% in CC homozygotes (OR=0.48, 95% CI: 0.33-0.72). Conclusion Our results show association of rs4939827 with colorectal cancer risk in Croatian population. The higher strength of the association in comparison to other studies suggests population-specific environmental or genetic factors may be modifying the association. More studies are needed to further describe role of rs4939827 in CRC. Likely reason for failure of replication for other 3 loci is inadequate study power.
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