Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Except for Salmonella spp., all Enterobacteriaceae produce intrinsic chromosomal encoded beta-lactamases which, beside their physiologic role in cell-wall synthesis and natural beta-lactam protection, are responsible for intrinsic resistance of individual species among Enterobacteriaceae. E. coli and Shigella spp. produce a small amount of AmpC beta-lactamases and are susceptible to ampicillin and other beta-lactam antibiotic agents. Enterobacter spp, C. freundii, Serratia spp., M. morganii, P. stuarti and P. rettgeri produce small amounts of inducible AmpC beta-lactamases which are not inhibited by beta-lactamases inhibitor, causing intrinsic resistance to ampicillin, co-amoxiclav and first-generation cephalosporins. ⋯ Enterobacter spp. and C. freundii) can be recognized by cefoxitin/cefotaxime disk antagonism tests. Since clinical laboratories are first to encounter bacteria with new forms of antibiotic resistance, they need appropriate tools to recognize these bacteria, including trained staff with sufficient time and equipment to follow up important observations. Because bacterial pathogenes are constantly changing, training must be an ongoing process.
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According to the International Association for the Study of Pain (IASP) neuropathic pain is "pain initiated or caused by a primary lesion or dysfunction or transitory perturbation in the peripheral or central nervous system". Neuropathic pain is usually classified according to the etiology, location of the lesion, and pain characteristics--individual symptoms and signs, but also according to the possible mechanisms involved. Identifying the underlying pain mechanisms during the diagnosis becomes essential for treatment strategies. ⋯ In spite of a variety of drug classes used to treat neuropathic pain including antidepressants, anticonvulsants, antiarrhythmics, opioids, local anesthetic blockers, neuropathic pain remains difficult to treat. The possibility to select specific drugs and treatments for the individual patient lies in elucidating the relationships between clinical neuropathic states and underlying pathophysiologic changes. Progress in defining the mechanisms involved in neuropathic pain, based on further clinical studies and fundamental investigations, will improve therapeutic management of neuropathic pain.
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Acute renal failure (ARF) is an unusual and severe complication which may occur in patients following cardiac surgery. The incidence of ARF is from 1% to 15% (according to some authors up to 40%). The ARF, occurring in the postoperative period and requiring dialysis is an important risk factor for early mortality, while the overall mortality due to this complication is as high as 40% (40% to 90%). ⋯ The incidence of ARF in patients undergoing cardiac surgery was low (2.1%). The incidence of severe ARF (which must be treated with dialysis) was 0.3%. We compared the data obtained at our hospital with those obtained 17 years ago and found a reduction in the incidence of severe ARF after cardiac surgery (0.3% vs. 4%).
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The diagnosis of acute myocardial infarction (AMI) and unstable angina is based on typical clinical signs, electrocardiogram (ECG) changes, and serial measurements of characteristic serum enzymes, especially troponins. Today, newer biochemical markers are used in assessing these conditions, as well as minor myocardial damage (MMD). ⋯ CK-MBact (92.3%) showed the highest specificity, followed by c-TnI (88.5%) and c-TnT (75.6%). The sensitivity was low for all markers analyzed. Concerning specificity, CK-MBact proved to be the best biologic marker for the assessment of MMD, followed by c-TnI and c-TnT. Correct clinical assessment according to marker accuracy and discrimination can be achieved by use of c-TnI, however, with a moderate degree of accuracy and discrimination for the detection of MMD in critically ill patients admitted to ICU.
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To determine whether sequential change in coagulation parameters such as activated partial thromboplastin time (aPTT), prothrombin time (PT), platelets count and fibrinogen level may predict the outcome of patients in sepsis. ⋯ The coagulation parameters PT, aPTT, platelet count and fibrinogen level can not serve as predictors of outcome in patients with sepsis. Further studies including more discerning coagulation parameters: AT III, D-dimer, soluble fibrin monomer, thrombin/antithrombin complex, plasmin/antiplasmin complex, fibrinopeptid A, fibrinopeptid B are necessary to evaluate whether these procoagulant and anticoagulant factors may help in predicting outcome and severity of sepsis.