Srp Ark Celok Lek
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Secondary monotherapy failure in diabetes mellitus type 2 occurs early in the course of disease. Choosing the optimal combination therapy depends on the primary pathogenic mechanism. Evaluation of the residual beta cell function is of primary importance in deciding whether insulin should be included in the combination therapy. ⋯ Clinical diagnosis of metabolic syndrome and evaluation of residual insulin secretion are necessary in choosing the best combination therapy in secondary SU failure in subjects with type 2 diabetes. Stimulated standard meal CP level is a clinically useful marker of residual insulin secretion.
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Currently, in our country (Republic of Serbia) tetanus is a rarely occurring disease, mainly affecting people older than 65 years of age. A small number of reported cases is mainly due to appropriate immunization. Therefore, each case of tetanus may be considered as failure of health care system to provide adequate immunization. ⋯ Tetanus is a severe, potentially lethal disease that is absolutely preventable. Mistakes in immunization and surgical treatment of the wound can be considered as medical malpractice.
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Case Reports
[Pacemaker optimization guided by echocardiography in cardiac resynchronization therapy].
Cardiac resynchronization therapy (CRT) or biventricular pacing is a contemporary treatment in the management of advanced heart failure. Echocardiography plays an evolving and important role in patient selection for CRT, follow-up of acute and chronic CRT effects and optimization of device settings after biventricular pacemaker implantation. In this paper we illustrate usefulness of echocardiography for successful AV and VV timing optimization in patients with CRT. A review of up-to-date literature concerning rationale for AV and VV delay optimization, echocardiographic protocols and current recommendations for AV and VV optimization after CRT are also presented. ⋯ Optimal management of patients treated with CRT integrate both clinical and echocardiographic follow-up with, if needed, echocardiographically guided optimization of AV and VV delays, which offers the possibility of additional clinical improvement in such patients.
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Case Reports
[Neurotoxicity during induction treatment of childhood acute lymphoblastic leukaemia--two case reports].
During chemotherapy of acute lymphoblastic leukaemia (ALL), children sometimes exhibit neurological disturbances. Chemiotherapeutic regimens include methotrexate, administered either intravenously or via intrathecal route. Although multiple drugs are used in addition to methotrexate, the acute neurotoxicity reported in patients is usually attributed to methotrexate. The acute neurotoxicity usually results in stroke-like symptoms such as aphasia, weakness, sensory deficits, ataxia and seizures. ⋯ The neurotoxicity in patients with ALL can be combined with significant structural changes of the brain, but also morphological changes can be absent. Several questions concerning aetiology and treatment of neurological events are raised.
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Comparative Study
[Bernard Organ Failure Score in estimation of most severe forms of acute pancreatitis].
Despite intensive research, efforts and clinical investigations on pathogenesis of acute pancreatitis (AP) and system morbidity during the illness onset, mortality is still very high in the group of severe forms. A significantly high number of patients show moderate, self-limited forms of illness, with a minimal degree of systemic or local complications, with full recovery. However, some of them have a severe form, followed by a high percent of morbidity and mortality, and system organ failure. The distinction between mild and severe forms of AP within 24-48 hours of hospital admission is very important for the treatment of these patients. The usage of multifactorial scoring systems holds a lot of promise, reaching reliability in the disease severity estimation of approximately 70-80%. ⋯ The concept of the BOFS score has more advantages than the APACHE II score in the patients with severe forms of AP with organ dysfunction.