Izhodišča: Vstavitev trajnega drenažnega plevralnega katetra (TDPK) nudi možnost trajnega paliativnega zdravljenja malignega plevralnega izliva (MPI). Namen naše raziskave je oceniti uporabnost in ...varnost zdravljenja naših bolnikov s TDPK pri ponavljajočih se MPI.
Metode: V retrospektivno kohortno raziskavo smo vključili 105 bolnikov z MPI, pri katerih smo med aprilom 2009 in julijem 2017 na Univerzitetni kliniki Golnik vstavili TDPK. Analizirali smo demografske podatke, indikacijo za vstavitev TDPK, zaplete in delež spontane plevrodeze.
Rezultati: Med pogostejšimi vzroki MPI pri vključenih bolnikih so bili pljučni rak (59,0 %), mezoteliom (9,5 %), rak dojke (6,7 %) in rak jajčnikov (4,8 %). Razlog za vstavitev TDPK namesto opravljene plevrodeze je bil nepopolno razpenjanje pljuč pri 50 (47,6 %) bolnikih, slaba splošna zmogljivost, kratko pričakovano preživetje ali pridružene bolezni pri 50 (47,6 %) in dotlej neuspešno opravljene torakoskopske plevrodeze pri 5 (4,8 %) bolnikih. Do zapletov je prišlo pri 14 (13,3 %) bolnikih: zamašitev katetra pri 7, izpad katetra pri 3, zatekanje ob katetru pri 2 in okužba pri 2 bolnikih (empiem pri enem bolniku in celulitis pri enem bolniku). Plevrodeza, ki je omogočila odstranitev katetra, je bila dosežena pri 10 (9,5 %) bolnikih.
Zaključek: Vstavitev TDPK je varna in učinkovita metoda trajnega paliativnega zdravljenja MPI.
Background: Pleural fluid biochemical analysis is the first step in pleural effusion (PE) diagnostics. Our purpose was to analyse the utility of the biomarkers used at our clinic in the routine ...diagnosis of PE.Methods: We retrospectively reviewed the PE levels of proteins, lactate dehydrogenase (LDH), alpha amylase (AA), pH and glucose in 433 patients who were treated at the University Clinic Golnik in a one-year period and compared these values with the final identified aetiology of the effusions.Results: The majority of the effusions were determined to be a consequence of malignancy (n = 154) or infection (n = 108). In 94 cases the aetiology of the effusions was heart failure and in 54 cases other diseases, while 23 effusions remained aetiologically undetermined. Considering Light’s criteria, the vast majority of the effusions were correctly classified as exudates or transudates (97.1 %). Comparing paramalignant and malignant effusions, we detected significantly lower values of pleural fluid LDH (p < 0.0005) and proteins (p < 0.0005), and higher pH (p < 0.0005) values in the paramalignant effusions.Conclusion: We have found that pleural LDH and proteins are the most helpful biochemical parameters in our routine diagnosis of pleural effusions and helped us to correctly narrow the aetiological spectrum. Furthermore, significantly higher pleural LDH and protein values and a pH below 7.32 additionally facilitated distinguishing between malignant and paramalignant effusions. Parameters such as glucose and AA are useful in selected cases and have a limited role in routine diagnostics.
Background: Empiric therapy is a mainstay of Helicobacter pylori eradication strategy. With the epidemics of antimicrobial resistance, it is becoming increasingly difficult to select treatment with ...at least two active antimicrobial agents, needed for cure. Tailored therapy has not been widely accepted in the past, but has lately resurged as a viable alternative. The aim of the study was to review all available studies comparing tailored and empiric therapies in the treatment of nave adult patients. Methods: PubMed database search was conducted for eligible studies from 1996 to 2016 in the English language. All relevant studies were included. Studies that compared standard triple and tailored therapies were included in the meta-analysis. Cumulative relative risk (RR) for eradication success was calculated. Results: Eight studies integrating 2521 participants were evaluated and 7 integrating 1853 patients were included in the meta-analysis. Dierent tailored approaches were recognized. However, all studies favoured tailored over empiric strategy. Cumulative RR was 1.27 (1.18-1.37) for intention-to-treat (ITT) analysis and 1.28 (1.18-1.38) for per-protocol (PP) analysis. Conclusion: Based on available evidence, tailored therapy is a better alternative to standard triple therapy for eradication of H. pylori. Evidence shows that such approach is also cost eective.
Background. Empiric therapy is a mainstay of Helicobacter pylori eradication strategy. With the epidemics of antimicrobial resistance, it is becoming increasingly difficult to select treatment with ...at least two active antimicrobial agents, needed for cure. Tailored therapy has not been widely accepted in the past, but has lately resurged as a viable alternative. The aim of the study was to review all available studies comparing tailored and empiric therapy in treatment naïve adult patients.Methods. PubMed database search was conducted for eligible studies from 1996 to 2016 in English language. All relevant studies were included. Studies that compared standard triple and tailored therapy were included in the meta-analysis. Cumulative relative risk (RR) for eradication success was calculated.Results. Eight studies integrating 2521 participants were evaluated and 7 integrating 1853 patients were included in the meta-analysis. Different tailored approaches were recognized. However, all studies favoured tailored over empiric strategy. Cumulative RR was 1.27 (1.18-1.27) for intention-to-treat (ITT) analysis and 1.28 (1.18-1.38) for per-protocol (PP) analysis.Conclusion. Based on available evidence, tailored therapy is a better alternative to standard triple therapy for eradication of H. pylori. Evidence exist that such approach is also cost effective.
Background. Empiric therapy is a mainstay of Helicobacter pylori eradication strategy. With the epidemics of antimicrobial resistance, it is becoming increasingly difficult to select treatment with ...at least two active antimicrobial agents, needed for cure. Tailored therapy has not been widely accepted in the past, but has lately resurged as a viable alternative. The aim of the study was to review all available studies comparing tailored and empiric therapy in treatment naïve adult patients.Methods. PubMed database search was conducted for eligible studies from 1996 to 2016 in English language. All relevant studies were included. Studies that compared standard triple and tailored therapy were included in the meta-analysis. Cumulative relative risk (RR) for eradication success was calculated.Results. Eight studies integrating 2521 participants were evaluated and 7 integrating 1853 patients were included in the meta-analysis. Different tailored approaches were recognized. However, all studies favoured tailored over empiric strategy. Cumulative RR was 1.27 (1.18-1.27) for intention-to-treat (ITT) analysis and 1.28 (1.18-1.38) for per-protocol (PP) analysis.Conclusion. Based on available evidence, tailored therapy is a better alternative to standard triple therapy for eradication of H. pylori. Evidence exist that such approach is also cost effective.
Objective: Telemonitoring seems to be a useful tool for patients' management. The aim of our project was to test the applicability and potential effects of a 12-month telemonitoring of patients with ...asthma supported by information and communication technologies. Methods: We included 100 patients with asthma followed in the outpatient pulmonary clinic in a randomized controlled clinical trial. The patients' data were collected by study questionnaires and lung function tests at the inclusion and at the end of interventional period. In the interventional group, asthma control test (ACT) and peak expiratory flow measurements (PEF) were stimulated to be regularly reported by Short Message Service (SMS). As a response to reported values, the patients automatically received a preformed text or a call from a study nurse in case of detected predefined critical values. Results: The compliance of reporting PEF and ACT values was higher than 80% in 96% of patients. Although we did not detect significant differences in ACT score improvement between the two study groups, we found more prominent improvement of ACT score in the subgroup of patients with two or more exacerbations prior to inclusion in the interventional group, compared to the control group. 40 (78%) patients in the interventional group listed at least one positive effect of telemonitoring on management of asthma. Conclusions: The developed program for home monitoring of patients with asthma was applicable and offered the patients support in managing their disease. Further studies with more selected patients are needed to confirm its usefulness in improving asthma control.
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