Measuring the quality of life (QoL) of women with breast cancer is an important aspect of measuring treatment success. In Croatia, no QoL studies have been carried out with a focus on patients after ...mastectomy. The aim of this study was to examine QoL 1 month and 1 year after mastectomy.
This cross-sectional single-center study of quality of life was conducted in 101 patients, 50 of whom had undergone a mastectomy 1 month prior, and 51 of whom had undergone a mastectomy 1 year prior. The study was conducted from July 2015 to June 2016. The questionnaires used in the study were developed by the European Organisation for Research and Treatment of Cancer (EORTC). The questionnaire EORTC QLQ-C30 assesses the QoL of cancer patients, and the questionnaire EORTC QLQ-BR23 is a disease-specific breast cancer module. A chi square test, Fisher's exact test, Kolmogorov-Smirnov test, Student's t-test and Mann-Whitney U test were performed in the statistical analysis using the statistical program SPSS (Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc.).
Patients who had undergone a mastectomy a year earlier placed a higher value on their health state than did those who had undergone a mastectomy a month earlier. The most affected values of functional status on the EORTC QLQ-C30 scale were emotional functioning (37.5 95% CI 33.3-61.6) and sexual functioning (16.67 95% CI 0-33.3) 1 month and 1 year after mastectomy, respectively. The most affected symptoms on the EORTC QLQ-C30 scale were hair loss 66.67 95% CI 33.3-100) and fatigue 33.33 95% CI 24-44) 1 month and 1 year after mastectomy, respectively.
In our study, both functional and symptom scales were more affected in women 1 month after mastectomy. QoL was considerably improved in women 1 year after the surgery compared to 1 month after mastectomy. The results of this study could contribute to the public awareness of the QoL of breast cancer patients.
Sudden cardiac death (SCD) is an unexpected and dramatic event. It draws special attention especially in young, seemingly healthy athletes. Our scientific paper is based on the death of a young, ...23-year-old professional footballer, who died on the football field after a two-year history of cardiac symptoms. In this study we analyzed clinical, ECG and laboratory data, as well as results of genetic testing analysis in family members. To elucidate potential genetic etiology of SCD in this family, our analysis included 294 genes related to various cardiac conditions.
The Republic of Croatia, with a gross domestic product per capita of US$11,554 in 2008, is an economically less-developed Western country. The goal of the present investigation was to prove that a ...well-organized primary percutaneous coronary intervention network in an economically less-developed country equalizes the prospects of all patients with acute ST-segment elevation myocardial infarction at a level comparable to that of more economically developed countries. We prospectively investigated 1,190 patients with acute ST-segment elevation myocardial infarction treated with primary PCI in 8 centers across Croatia (677 nontransferred and 513 transferred). The postprocedural Thrombolysis In Myocardial Infarction flow, in-hospital mortality, and incidence of major adverse cardiovascular events (ie, mortality, pectoral angina, restenosis, reinfarction, coronary artery bypass graft, and cerebrovascular accident rate) during 6 months of follow-up were compared between the nontransferred and transferred subgroups and in the subgroups of older patients, women, and those with cardiogenic shock. In all investigated patients, the average door-to-balloon time was 108 minutes, and the total ischemic time was 265 minutes. Postprocedural Thrombolysis In Myocardial Infarction 3 flow was established in 87.1% of the patients, and the in-hospital mortality rate was 4.4%. No statistically significant difference was found in the results of treatment between the transferred and nontransferred patients overall or in the subgroups of patients >75 years, women, and those with cardiogenic shock. In conclusion, the Croatian Primary Percutaneous Coronary Intervention Network has ensured treatment results of acute ST-segment elevation myocardial infarction comparable to those of randomized studies and registries of more economically developed countries.
A change of the paradigm in the treatment of some diseases rarely changed so radically as the strategy for the treatment of acute myocardial infarction (AMI) has changed over the last few decades. A ...long period with a completely passive and expectative attitude was followed by two radical revolutions. The first occurred in the eighties by introducing fibrinolytic therapy, while the other was even more spectacular, when primary percutaneous coronary interventions (PCI) were introduced, being accompanied by a significant decrease in mortality. The second wave affected us in Croatia 10 years ago, whereas intervention skills, technology and enthusiasm were the trias in the genesis of success. If we drew a cross-section today, we can ask ourselves -- What is next to do? Have we reached the maximum which is followed by the plateau or is there still room for upward curve of success? This second variant seems to be more realistic. The reasons for this can be found primarily in spreading PCI to non-ST segment elevation myocardial infarction (NSTEMI), that are subject to less invasive strategy or strategy of longer waiting for PCI, significantly longer in practice than what is prescribed in the guidelines, which can explain epidemiological data of the difference in mortality between STsegment elevation myocardial infarction (STEMI) and NSTEMI in some follow-ups. Another moment is the limitations of electrocardiographic methods in the classification of AMI, which determines the treatment strategy. The differences reflected by the electrocardiographic method are not always an expression of real pathophysiologic events, so the treatment strategy should not be different. In addition to the methods of unmasking false NSTEMI and real STEMI showing terminology inadequacy of the existing names, we should take into account the technological advance in the diagnostics of AMI, as a potential moment for further jump. Imaging methods in cardiology have not yet, at least in our regions, taken their full advantage and we can expect that diagnostic hodograms will change when they become available. To conclude, we can say that there is still a lot of work to do for us to optimize the approach to the treatment of acute coronary syndrome.
Concurrent spontaneous hemopericardium and hemothorax due to anticoagulant use are extremely rare in clinical practice. Dabigatran is an oral direct thrombin inhibitor approved to prevent stroke or ...thromboembolic episodes in patients with nonvalvular atrial fibrillation. We report the case of a 73-year-old man who received dabigatran therapy (150 mg twice a day) for 3 months and developed massive spontaneous hemothorax and hemopericardium associated with fever. Emergency chest computed tomography scan established higher-density pericardial effusion (22HU) and left pleural effusion of heterogeneous density (5–15 HU) which could be hemorrhagic content while the heart ultrasound finding confirmed pericardial effusion 7–9 mm thick, without affecting hemodynamics. Almost 1100 mL of blood was drained by ultrasoundguided thoracentesis. After excluding other possible causes, diagnostic withdrawal was performed for dabigatran and no further pleural or pericardium effusion developed after dabigatran was discontinued. Therefore, practitioners could be aware of hemothorax as well as hemopericardium as a potential complication of dabigatran therapy.
Istodobno
spontani hemoperikard i hemotoraks tijekom primjene oralnih antikoagulanata
izuzetno je rijetka pojava u kliničkoj praksi. Dabigatran je oralni izravni
inhibitor trombina odobren za prevenciju moždanog udara ili tromboembolijskih događaja
u bolesnika s nevalvularnom fibrilacijom atrija. Prikazan je slučaj
73-godišnjaka na terapiji dabigatranom (150 mg dva puta dnevno) od 3 mjeseca sa
razvojem masivnog spontanog hemotoraksa i hemoperikarda praćeno vrućicom.
Višeslojna kompjutorizirana tomografija (MSCT) toraksa je pokazala
perikardijalni izljev veće gustoće (22HU) kao lijevi pleuralni izljev
heterogene gustoće (5–15 HU), opisano kao mogući hemoragični sadržaj, dok je
nalaz ultrazvuka srca verificirao perikardijalni izljev od 7–9 mm, bez utjecaja
na hemodinamiku. Torakocentezom se evakuira gotovo 1100 ml krvi. Urađenom
kliničkom obradom isključeni su drugi uzroci te se izostavljanjem dabigatrana
iz terapije prekinulo daljnje nakupljanje krvi u perikard ili pleuralni
prostor. Tijekom primjene dabigatrana moguć je potencijalni nastanak
hemoragičnih komplikacija na koje svakako treba pomišljati.
Concurrent spontaneous hemopericardium and hemothorax due to anticoagulant use are extremely rare in clinical practice. Dabigatran is an oral direct thrombin inhibitor approved to prevent stroke or ...thromboembolic episodes in patients with nonvalvular atrial fibrillation. We report the case of a 73-year-old man who received dabigatran therapy (150 mg twice a day) for 3 months and developed massive spontaneous hemothorax and hemopericardium associated with fever. Emergency chest computed tomography scan established higher-density pericardial effusion (22HU) and left pleural effusion of heterogeneous density (5–15 HU) which could be hemorrhagic content while the heart ultrasound finding confirmed pericardial effusion 7–9 mm thick, without affecting hemodynamics. Almost 1100 mL of blood was drained by ultrasoundguided thoracentesis. After excluding other possible causes, diagnostic withdrawal was performed for dabigatran and no further pleural or pericardium effusion developed after dabigatran was discontinued. Therefore, practitioners could be aware of hemothorax as well as hemopericardium as a potential complication of dabigatran therapy.
Heart failure with reduced ejection fraction (HFrEF) is a
progressive clinical syndrome defined by changes in the myocardial structure,
which lead to predominant systolic myocardial function ...impairment, with a left
ventricle ejection of fraction ≤40%. The rehospitalization burden in HFrEF
patients (pts) remains very high, with poor quality of life, increased
mortality and large healthcare expenditures. In this research project, we
investigated the risk factors for first and repeated hospitalization in pts
with HFrEF. This retrospective study included 50 adult pts with a diagnosis of
HFrEF and who were within the age range of 55 to 89 years old and of both
sexes. Demographic and clinical data (HFrEF etiology, renal function
parameters, complete blood count, markers of nflammation, electrocardiogram, troponin I, NTproBNP, echocardiographic
parameters and comorbidities data) were collected from the pts’ medical
histories. Statistical analysis was performed via Fischer’s exact test, the
Shapiro-Wilk test and the Spearman correlation coefficient. This study included
70% male and 30% female HFrEF pts. Males were younger in both group of pts and
had a higher incidence of rehospitalization. The most important HFrEF etiologic
risk factors are arterial hypertension (82%), coronary heart disease (54%),
atrial fibrillation (52%) and diabetes mellitus (40%). The most important noncardiac
comorbidity related with the first HFrEF hospitalization is pneumonia (P=0.03),
while progression of left ventricle systolic and diastolic dysfunction is
related to rehospitalization risk (left ventricle end systolic diameter,
P=0.003; diastolic dysfunction degree, P=0.04). The troponin level was
associated with an increased risk of rehospitalization, but this was not statistically
significant at this sample size (troponin I, p=0.10). Following the first and
repeated hospitalizations of HFrEF pts, comorbidities, ageing and gender
difference are crucial to HFrEF development, while echocardiographic parameters
and biomarkers critically affect HFrEF rehospitalization risk.
Srčano popuštanje s reduciranom ejekcijskom frakcijom (HFrEF)
progresivni je klinički sindrom definiran strukturnim promjenama miokarda koji
dovodi prvenstveno do oštećenja sistoličke funkcije s redukcijom ejekcijske
frakcije lijeve klijetke ≤40 %. Učestalost ponovne hospitalizacije pacijenata s
HfrEF-om vrlo je visoka, smanjuje kvalitetu života, povećava stopu smrtnosti i
veliko je financijsko opterećenje zdravstvenome sustavu. U istraživanju su
proučavani rizični čimbenici za prvu i ponovnu hospitalizaciju kod pacijenata s
HfrEF-om. U ovu retrospektivnu studiju uključeno je 50 odraslih pacijenata s
dijagnozom HfrEF-a, životne dobi između 55 i 89 godina, oba spola. Demografski
i klinički podaci (etiologija HfrEF-a, parametri bubrežne funkcije, kompletna
krvna slika, biljezi upale, elektrokardiogram, troponin I, NTproBNP,
ehokardiografski parametri, komorbiditeti) prikupljeni su iz medicinske
dokumentacije pacijenata. Statistička analiza učinjena je Fischerovim egzaktnim
testom, Shapiro-Wilk testom i Spearmanovim koeficijentom korelacije. U studiju
je uključeno 70% muškaraca i 30% žena s HfrEF-om, muškarci su u obje praćene
skupine bili mlađe životne dobi te su imali veću incidenciju rehospitalizacije.
Najznačajniji etiološki čimbenici rizika za HFrEF su arterijska hipertenzija
(82%), koronarna bolest (54%), atrijska fibrilacija (52%), šećerna bolest
(40%). Od nekardioloških komorbiditeta vezanih uz prvu hospitalizaciju
pacijenata s HfrEF-om najznačajnija je pneumonija (P = 0,03), dok je pogoršanje
sistoličke i dijastoličke funkcije lijeve klijetke vezano uz ponovnu
hospitalizaciju (end-sistolički promjer lijeve klijetke, P = 0,003; stupanj
dijastoličke disfunkcije, P = 0,04). Biomarker troponin I pokazao je tendenciju
porasta u rehospitalizaciji, ali bez statističke značajnosti na ovoj veličini
uzorka (troponin I, p = 0,10). Komorbiditeti, starenje i spol ključni su za
razvoj HFrEF-a, dok su ehokardiografski parametri i biomarkeri ključni za
rehospitalizaciju.
Heart failure with reduced ejection fraction (HFrEF) is a progressive clinical syndrome defined by changes in the myocardial structure, which lead to predominant systolic myocardial function ...impairment, with a left ventricle ejection of fraction ≤40%. The rehospitalization burden in HFrEF patients (pts) remains very high, with poor quality of life, increased mortality and large healthcare expenditures. In this research project, we investigated the risk factors for first and repeated hospitalization in pts with HFrEF. This retrospective study included 50 adult pts with a diagnosis of HFrEF and who were within the age range of 55 to 89 years old and of both sexes. Demographic and clinical data (HFrEF etiology, renal function parameters, complete blood count, markers of inflammation, electrocardiogram, troponin I, NTproBNP, echocardiographic parameters and comorbidities data) were collected from the pts' medical histories. Statistical analysis was performed via Fischer's exact test, the Shapiro-Wilk test and the Spearman correlation coefficient. This study included 70% male and 30% female HFrEF pts. Males were younger in both group of pts and had a higher incidence of rehospitalization. The most important HFrEF etiologic risk factors are arterial hypertension (82%), coronary heart disease (54%), atrial fibrillation (52%) and diabetes mellitus (40%). The most important noncardiac comorbidity related with the first HFrEF hospitalization is pneumonia (P=0.03), while progression of left ventricle systolic and diastolic dysfunction is related to rehospitalization risk (left ventricle end systolic diameter, P=0.003; diastolic dysfunction degree, P=0.04). The troponin level was associated with an increased risk of rehospitalization, but this was not statistically significant at this sample size (troponin I, p=0.10). Following the first and repeated hospitalizations of HFrEF pts, comorbidities, ageing and gender difference are crucial to HFrEF development, while echocardiographic parameters and biomarkers critically affect HFrEF rehospitalization risk.
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