Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Practice Guideline
[Diagnosis and conservative treatment of low back pain: review and guidelines of the Croatian Vertebrologic Society].
Low back pain (LBP) is a very common condition with high costs of patient care. Medical doctors of various specialties from Croatia have brought an up-to-date review and guidelines for diagnosis and conservative treatment of low back pain, which should result in the application of evidence-based care and eventually better outcomes. As LBP is a multifactorial disease, it is often not possible to identify which factors may be responsible for the onset of LBP and to what extent they aggravate the patient's symptoms. ⋯ Besides providing education, in patients with acute back pain, advice seems to be crucial (especially to remain active), along with the use of drugs (primarily in terms of pain control), while in some patients spinal manipulation (performed by educated professional) or/and short-term use of lumbosacral orthotic devices can also be considered. The main goal of treating patients with chronic LBP is renewal of function, even in case of persistent pain. For chronic LBP, along with education and medical treatment, therapeutic exercise, physical therapy and massage are recommended, while in patients with a high level of disability intensive multidisciplinary biopsychosocial approach has proved to be effective.
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Case Reports
[Patient who developed heparin-induced thrombocytopenia type II after 24 years on hemodialysis].
Heparin-induced thrombocytopenia type II (HIT) is a clinicopathologic syndrome in which one or more clinical events are temporally related to heparin administration and caused by HIT antibodies. There are at least five different types of clinical events that are associated with HIT: thrombocytopenia; thrombosis; skin necrosis at heparin injection site, venous limb gangrene; and an acute systemic reaction that occurs 5-30 min after intravenous bolus of heparin. HIT typically presents 5-14 days after initiation of heparin therapy, later onset is unusual. ⋯ HIT type II is a rare but potentially fatal syndrome that can develop years after start of heparin therapy. To our knowledge, this is the patient with longest hemodialysis vintage and newly diagnosed HIT. This is also the first case of patient on hemodialysis that developed HIT in Croatia published to date.
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Biography Historical Article
[Midwifery ordinance of Joannis Baptiste Lalangue in the context of the historical development midwifery in Croatia].
Joannis Baptiste Lalangue was the author of the first published rules for performance of midwifery activities printed in Croatian language (Nagovorni lizt, Zagreb, Trattner, 1785), which is extremely important information for the study of the history of Croatian midwifery. The work contains the first printed oath of midwifery in Croatian language, and has not been known in the medical professional literature to date. Lalangue was the founder of the Croatian midwifery, who gave us the first tutorial and first printed rulebook for performing midwifery services in Croatian language. ⋯ After successful completion of training in Varazdin, midwives were authorized to perform midwifery services, and after that initial 'licensing', in order to perform midwifery activity they had to undergo mandatory and statutory testing of knowledge and skills as a prerequisite for 'relicensing', which gave them right to perform midwifery services. This is the basis of the training and continuous education of Croatian midwives to the present, which is consistent with the achievements of modern midwifery and Lalangue's tenets. Lalangue's works were used in systematic training and education of midwives and they, along with their author, have place in the history of Croatian midwifery.
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Acute kidney injury (AKI) is an important clinical issue, especially in the setting of critical care. It has been shown in multiple studies to be a key independent risk factor for mortality, even after adjustment for demographics and severity of illness. There is wide agreement that a generally applicable classification system is required for AKI which helps to standardize estimation of severity of renal disfunction and to predict outcome associated with this condition. ⋯ As gold standard, radioisolopic measurement of volume is impractical in the acute care enviroment. Newer technologies offer the promise of both rapid and accurate bedside estimation of volume status with the potential to improve clinical outcomes. Blood assessment with bioimpendance vector analysis, and bedside ultrasound seem to be promising technologies for this need.
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A large number of individuals experiencing anaphylactic reaction to neuromuscular blocking agents have not previously been in contact with them. The search for a substance inducing sensitization to muscle relaxants has led Norwegian and Swedish scientists to pholcodine, a cough suppressant, which is widely used in Europe and worldwide. ⋯ Based on the results of published studies that pointed to a connection of the use of pholcodine and perioperative anaphylactic reaction, pholcodine was withdrawn from the Norwegian market and subsequent research revealed a reduction of anaphylactic reactions in that country. In its latest report, the European Medicines Agency made a decision not to withdraw pholcodine mixtures from the market but it urged further research with the aim to clarify the cross-reactivity between pholcodine and neuromuscular blocking agents.