An accurate and reproducible method for the evaluation of postoperative morbidity is essential for a valid assessment of the outcomes of surgery. However, there is still no consensus on reporting of ...complications. The Clavien-Dindo classification (CDC) of complications is a validated system which reports only the most severe complication. The Comprehensive Complication Index (CCI) is a novel scale designed to capture the overall burden of complications. The aim of our study is to validate and compare the CDC and the CCI in the setting of high-risk surgical patients in whom multiple complications are common.
A prospective, observational study analyzed 206 high-risk adult patients undergoing major abdominal surgery. Each postoperative complication was recorded until discharge or readmission within 30 days. The severity of complications was graded with the CDC, and the CCI was calculated subsequently. Correlations of the CDC and the CCI with hospitalization indicators and functional activity on discharge were assessed and compared.
A total of 424 complications occurred in 125 (60.7%) patients. The median CCI for the cohort was 20.9 (0-44.9). CD grade II was the most frequent among patients with complications (62/125; 49.6%). The CCI and the CDC have shown a strong correlation (r = 0.969, P < 0.01). Both scales strongly correlated with the parameters of hospitalization, but the CCI showed a stronger correlation to the intensive care unit length of stay (LOS; 0.670 versus 0.628, P < 0.001), postoperative LOS (0.652 versus 0.630, P = 0.041), and prolonged intensive care unit LOS (0.604 versus 0.555, P < 0.001). The median CCI and the highest CD grade were significantly different respective to the functional activity on discharge (P < 0.001).
The CDC and the CCI are the effective methods for reporting of complications after major abdominal surgery. The CCI is a more accurate scale for use in high-risk patients and correlates better with the postoperative LOS.
Strategijsko manevrisanje proizvodom, cenom, distribucijom i promocijom kao elementima ponude suština je marketing koncepcije savremene banke. Pojava i razvoj globalne mreže radikalno je promenila ...sve elemente marketing miksa. Uspostavljanjem asortimana proizvoda i dinamičkim upravljanjem promenama u njegovoj strukturi banke usklađuju svoje mogućnosti sa potrebama klijenata. Trude se da ponude što bogatiji i dostupniji proizvodni asortiman. Teže da se prilagođavanjem ponude maksimalno približe zahtevima postojećih i potencijalnih korisnika. Ponuda često nadmašuje tražnju. Zbog toga se trude da odluke o oblikovanju proizvoda nikada ne donose bez saradnje s klijentima. Dostupnost različitih, prilagodljivih i cenovno konkurentnih bankarskih proizvoda fundiranih uz upotrebu informacionih tehnologija, postaje temelj bankarstva. Fokusiranost na klijenta, zaokružena ponuda proizvoda visokog kvaliteta i stalne inovacije predstavljaju ključni faktor uspešnosti poslovanja banaka.
•Higher prevalence of vitamin D deficiency was demonstrated in PD patients compared to control subjects.•Severity and stage of Parkinson’s disease were significantly associated with lower 25OHD ...concentration.•A higher frequency of G allele of CYP2R1 polymorphism was observed in all subgroups with vitamin D deficiency.
Vitamin D is a steroid hormone, known to be involved in the pathogenesis of various neurodegenerative disorders, including Parkinson’s disease (PD).
We aimed to clarify the relationship between hypovitaminosis D and the predisposition for PD and its clinical presentation. An additional aim was to examine the specific gene polymorphisms associated with vitamin D level.
Total level of 25(OH)-vitamin D (25(OH)D) was measured in the serum of parkinsonian patients (n = 113) and controls (n = 82) using a commercial immunoassay. Genetic analyses were performed using Taqman assays on Real Time PCR amplification system.
Higher frequency of vitamin D deficiency (<50 nmol/L) was observed in PD patients, compared to controls (40.7% and 23.2%, respectively, P = 0.010). It was also a positive predictive marker of PD (OR, 2.27; 95% CI, 1.206–4.298; P < 0.011). Significantly higher UPDRS (35.85 ± 1.35 and 32.09 ± 0.99, respectively, P = 0.023) and HY scores (2(1.5–2.5) and 1.5(1.0–2.0), respectively, P = 0.005) were present in patients with 25(OH)D level < 50 nmol/L compared to patients with 25(OH)D level ≥ 50 nmol/L. Despite some trends observed, differences in allelic and genotypic distribution between controls and patients, as well as between subgroups, did not reach the level of significance (P > 0.05).
Findings of this study confirm the hypothesis of a significant relationship between hypovitaminosis D and PD. We demonstrated higher prevalence of vitamin D deficiency in PD patients, as well as its predictive potential for the onset and progression of PD.
Coronavirus disease (COVID-19) in immunocompromised patients represents a major challenge for diagnostics, surveillance, and treatment. Some individuals remain SARS-CoV-2 PCR-positive for a prolonged ...period. The clinical and epidemiological significance of this phenomenon is not well understood. We report a case of a patient with a history of systemic lupus erythematosus (SLE) who has been persistently SARS-CoV-2 PCR positive for 9 months, with multiple thromboembolic complications, and development of nocardial brain abscess successfully treated with surgery and antibiotics.
History of drug allergy is of major concern during perioperative period. Medical records usually lack documents confirming the stated allergy. This study aimed to investigate the prevalence of ...self-reported drug allergies and their characteristics in adult Serbian surgical population, and to analyze their influence on drug prescription during perioperative period. The study enrolled patients scheduled for general surgery during a one-year period at a tertiary care hospital. They were questioned using a structured questionnaire about the existence of drug allergy and its nature. Medical records were examined after discharge to assess medical prescription during hospitalization. Of 1126 patients evaluated during the study period, 434 (38.5%) reported a total of 635 drug reactions. The most common allergy claim was to antibiotics (68%), nonsteroidal antiinflammatory drugs (16.4%) and iodine (3.9%). Women, urban residents and herbal drug consumers were more likely to state an allergy. The majority of reported reactions were cutaneous (72%) and respiratory (34%), while anaphylaxis was reported by 3.2% of patients. Only 38 (8.7%) patients had previously undergone any allergology testing. Retrospective chart review revealed that 26 (6%) patients were administered the drug to which they had reported allergic reaction in the past, with no adverse effects. Drug allergies are frequently self-reported in surgical population in Serbia, which is in contrast to a very low rate of explored and documented allergies. In order not to deny an effective treatment or postpone a surgery, health care practitioners should pay more attention to an accurate classification of adverse drug reactions.
We explored the cryptic speciation of the
species complex, characterised by intense karyotype evolution and reduced phenotypic variability that has produced different lineages, out of which 25 are ...described as chromosomal forms (CFs), so many cryptic species remain unnoticed. Although some of them should be classified as threatened, they lack the official nomenclature necessary to be involved in conservation strategies. Reproductive isolation between seven CFs has previously been demonstrated. To investigate the amount and dynamics of genetic discrepancy that follows chromosomal changes, infer speciation levels, and obtain phylogenetic patterns, we analysed mitochondrial
and
nucleotide polymorphism among 17 CFs-the highest number studied so far. Phylogenetic trees delineated 11 CFs as separate clades. Evolutionary divergence values overlapped with acknowledged higher taxonomic categories, or sometimes exceeded them. The fact that CFs with higher 2n are evolutionary older corresponds to the fusion hypothesis of
karyotype evolution. To participate in conservation strategies,
classification should follow the biological species concept, and proposed cryptic species should be formally named, despite a lack of classical morphometric discrepancy. We draw attention towards the
and
CFs, estimated to be endangered/critically endangered, and emphasise the need for detailed monitoring and population survey for other cryptic species.
Sedation in intensive care units Veličković, Jelena; Palibrk, Ivan
Serbian Journal of Anesthesia and Intensive Therapy,
2018, Letnik:
40, Številka:
1-2
Journal Article
Recenzirano
Odprti dostop
Critically ill patients during the treatment in the intensive care units (ICU) are exposed to various interventions and stressors from the environment that represent a significant source of ...discomfort. Sedative and analgesic medications are commonly administered to provide comfort and improve tolerance of ICU management. It has been recognized that pain and delirium, coupled with oversedation, are associated with increased morbidity and mortality if not properly addressed. Routine monitoring with reliable tools enables early detection of agitation and pain, thus avoiding excessive sedation and harsh consequences of delirium. Individual approach implies selection of medications that meet patient's needs while taking into account the presence of organ dysfunctions that may influence drug metabolism and predispose a patient to severe side effects of sedation. The current evidence reveals that a deep sedation should always be avoided as long as there is no mandatory clinical indication. The newest guidelines also suggest the use of non-benzodiazepine (either propofol or dexmedetomidine) sedation whenever feasible to improve clinical outcomes in mechanically ventilated patients. Aside from specific situations (increased intracranial pressure, the administration of muscle relaxants, seizures) the required goal should be an alert, cooperative patient who can tolerate necessary interventions in the ICU. It has been demonstrated that daily interruption of sedation and sleep promotion are beneficial in decreasing the duration of mechanical ventilation and decreasing the incidence of cognitive impairments. Further studies are needed to elucidate the association of non-pharmacological interventions with long-term psychological outcomes.
Neurological disorders have increasing prevalence. Patients who come for surgery and anesthesia are more common with neurological comorbidities. This comorbidity, which has significant consequences ...for the behavior, psychological and physical characteristics of patients, has a need for numerous medications. When meeting these patients, anesthesiologists want answers to the following questions: the duration of the disease and the degree of illness, used therapy, the quality of life, the influence of anesthetics on the disease and the effect of therapy on the performance of anesthesia, the continuation of therapy after intervention and postoperative recovery. Still there are two dilemmas, whether and when before anesthesia and surgical interventions to stop the use of drugs that allow the function of patients and what are the possible interactions of drugs with anesthesia? The most common neurological diseases with which the anesthesiologist face as comorbidities are: Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy, circulatory disorders, and lately increases the likelihood of coma patients. Answering on the questions above will help a doctor to decide on the type of anesthesia and which dosage of drugs he will use. If a patient is without restrictions in work and habits, then anesthesia in this case is the same as in a person without this comorbidity. The therapy for the existing disease should be carried out until surgery or anesthesia, and should be continued immediately after surgery. Due to the significant influence of used drugs and the nature of the disease, it is necessary to use lesser doses of relaxants, opioids and sedatives. The use of regional anesthesia has its place, and it is used when the degree of illness is such that it allows the patient to cooperate.
Sepsis is a medical emergency and therefore requires early identification and immediate management, which is not a matter of hours, but minutes. Since the first definition in 1991, sepsis remains a ...major challenge for clinicians and scientists. Despite significant advances in technology and therapy, mortality and cost of treatment are unacceptably high. Septic shock is the leading cause of mortality in critically ill patients. Cognitive impairment and functional disability were observed after survivors? long-term follow-up. Since its foundation in 2002, Surviving Sepsis Campaign aims to implement global strategies and to raise awareness of the challenges associated with sepsis. The implementation of guidelines and sepsis care bundles resulted in significant decrease in mortality. Hospital mortality is lower in hospitals with high versus low bundle compliance. Still, epidemiological data for sepsis are missing for low- and middleincome countries.
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