Prilozi / Makedonska akademija na naukite i umetnostite, Oddelenie za biološki i medicinski nauki = Contributions / Macedonian Academy of Sciences and Arts, Section of Biological and Medical Sciences
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Acute kidney injury (AKI) comprises several syndromes that are associated with a sudden decrease in renal function. AKI is a common condition especially among critically ill patients. It is typically multifactorial and of great prognostic significance. ⋯ Furthermore, as AKI is multi-factorial and heterogeneous in origin, it seems likely that not one single marker but a panel of biomarkers will be required to detect all subtypes of AKI early during their evolution. This has initiated proteomic studies to develop panels of biomarkers which may facilitate early detection of AKI. The present review will focus on the most important clinical studies evaluating the ability of single AKI biomarkers and on those in clinical proteomics that attempted to establish panels of biomarkers in urine for early and accurate AKI diagnosis and prognosis.
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Observational Study
Early prognosis in patients with community-acquired severe sepsis and septic shock: analysis of 184 consecutive cases.
To determine the risk factors on hospital mortality in patients with community-acquired severe sepsis and septic shock in the first 24 hours after admission to the intensive care unit. ⋯ Our results highlight the importance of three or more organ dys-functions, acute respiratory failure, positive blood culture and chronic heart failure as independent risk factors for mortality in the first 24 hours after admission in patients with severe sepsis and septic shock. This will benefit the early identification of patients at high risk for poor outcomes that contributes to intensive management and appropriate treatment interventions.
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The aim of the study is to determine the influence of remifentanil and remifentanil-plus-sevoflurane-induced anaesthesia on mean arterial pressure and heart-rate during controlled hypotension in children and to evaluate the quality of the operative field. ⋯ Demographic analyses showed that 13 of the patients were female, 17 of them were male, with an age-range of 4.75±3.2 years in the R group of patients and 3.5±4.1 in the R+S group of patients. Duration of hypotension was 135±4 minutes (R) and 120±3 minutes (R+S). Duration of anaesthesia was 160±10 minutes (R) and 140±9 minutes (R+S). The duration of surgery was 150±5 minutes (R) and 130±4 minutes (R+S). The time to reach hypotensive level was shorter in R+S group (5±1 minutes) than R group (7±6 minutes). There was no statistically significant difference in MAP values measured at T1, T2, T3 and T4 time intervals between the two groups of patients (R and R+S group). We achieved hypotensive anaesthesia levels of MAP in both group of patients. The influence of anesthesia on HR was analysed at the same time intervals. In T2 time interval (30 minutes after the induction of anaesthesia), HR values in R group patients were statistically significantly higher than referent hypotensive values in the R+S group of patients (70-80 bpm). We could see the same result of HR values at T3 and T4 time intervals (90 and 120 minutes after the induction) in R group patients compared with HR values in the R+S group. We achieved a hypotensive level of HR (70-80 bpm) only at R+S group of patients, which means that remifentanil in combination with sevoflurane is an excellent combination for maintaining hypotension during general anaesthesia. The lowest hypotensive level of HR was measured 120 minutes after the induction of anaesthesia in the R+S group of patients (69 bpm). Remifentanil and remifentanil in combination with sevoflurane are effective in inducing consistent and sustained controlled hypotension in children undergoing middle ear microsurgery.
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Recruitment manoeuvre (RM) can be defined as a strategy to increase transient transpulmonary pressure. This study was aimed to evaluate the efficacy of e-sigh recruitment manoeuvre on patients with acute respiratory distress syndrome (ARDS). Thirty patients who fulfilled ARDS criteria were included in this study. ⋯ We assessed the effects of these manoeuvres on: gas exchange and haemodynamic and respiratory mechanics at two time points. The patients had had a chest x-ray and thoracic computed tomography scan of the lungs after a day of the last recruitment manoeuvre, before inclusion was studied. E-sigh recruitment manoeuvre had a good impact on gas exchange and aeration of the lung and collapsed alveoli were reopened, which was objectively evaluated on x-ray and a CT scan of the lung.
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The aim of this study is to show the different diagnostic procedures and treatment in patients diagnosed with congenital choledochal cysts. Choledochal cysts are congenital anomalies of the bile ducts and include cystic dilatation of the extrahepatic and intrahepatic biliary ducts or both. The study shows ten patients diagnosed as having choledochal cysts. ⋯ Patients with Caroli disease were conservatively treated and 3 with interventional endoscopic procedures. Despite US evidence suggesting choledochal cyst diagnosis, other supportive radiographic imaging modalities such as MRCP, ERCP and PTC are required to define the precise cyst anatomy and are essential for the preoperative assessment. Total cyst excision is recommended for reducing cyst-related complications and risk of cholangiocarcinoma.