Medicinski pregled
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The burnout syndrome is a response to chronic emotional and interpersonal stressors which are related to workplace. Medicine is one of the professions at the greatest risk of suffering from burnout syndrome. The aim of this study was to assess the presence of stress and burnout syndrome in relation with age and length of service in the family medicine physicians in the Republic of Srpska. ⋯ Age and length of service have important influence on the level of stress and burnout syndrome: the older the physicians and the higher the length of service the higher the level of stress and the higher the risk of burnout syndrome.
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Multicenter Study
Early detection of asthma and chronic obstructive pulmonary disease in primary care patients.
Asthma and chronic obstructive pulmonary disease are often unrecognized and undertreated. The aim of this study was to describe the frequency of chronic obstructive pulmonary disease and asthma in primary care patients in Serbia, and to examine the agreement between general practitioners and pulmonologists on the diagnosis of chronic obstructive pulmonary disease and asthma. ⋯ A significant number of patients seen in the general practitioner's office were diagnosed with chronic obstructive pulmonary disease or asthma and half of them represent new cases. A substantial proportion of patients referred to a pulmonologist by primary care physicians have been misdiagnosed.
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The aim of the study was to analyze the prevalence of diabetic ketoacidosis during the period of 10 years (1999-2008) among children diagnosed with type 1 diabetes in Montenegro. ⋯ The frequency of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes in Montenegro is still high with a trend to decrease in the last ten years. In particular, children under 5 years of age are at a high risk of developing diabetic ketoacidosis at the onset.
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Epidural analgesia has become the most popular method for labor pain relief. Analgesia in Labor: Yes or No? Labor pain is a complex phenomenon with sensory, cognitive, motivational, emotional, social, and cultural variables. Pain and anxiety lead to adrenergic hyperactivity, hyperventilation, hypocapnia with reduced uteroplacental blood flow and uncoordinated uterine activity, so pain relief is recommended and even indicated in cases of maternal comorbidity. Analgesia in Labor: Method of Choice. The quality of epidural analgesia is better than the one achieved by parenteral or inhalation agents, with increased uteroplacental blood flow and improved fetal-maternal oxygenation. Epidural Analgesia in Labor: What is Specific? The increased weight, lumbar lordosis, soft tissue edema and engorgement of epidural veins make it more difficult to perform epidural block in pregnancy. Epidural puncture should be performed by medial approach, at L2-3 or L3-4 level by loss of resistance technique between contractions. Epidural Analgesia in Labor: What With? Local anesthetics, bupivacaine, levobupivacaine, ropivacaine, are used and they can be combined with small doses of opioids (fentanyl or sufentanyl). Epidural Analgesia in Labor: How? Available techniques are epidural, spinal and combined spinal--epidural analgesia. Epidural Analgesia in Labor: Controversies. The most important controversy is the influence ofepidural analgesia on operative or instrumental delivery rate. Low concentrations of local anesthetic in combination with small doses of opioids, together with active management of labor by an obstetrician, would lead to increased spontaneous delivery rate. ⋯ Although there still are some difficulties, complications and controversies, epidural analgesia provides safe and effective labor pain control.
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Case Reports
A case of severe ADAMTS13 deficiency presenting as thrombotic thrombocytopenic purpura in pregnancy.
Thrombotic thrombocytopenic purpura is a rare life-threatening disorder characterized by thrombocytopenia and microangiopathic hemolytic anemia. It is caused by the absent or severe deficiency of the von Willebrand Factor-cleaving protease named ADAMTS13. Pregnancy is a well recognized factor precipitating the appearance of the disease both in women that had reduced levels of ADAMTS13 activity prior to gestation and in those with other inherited or acquired thrombophilic syndromes. ⋯ Severe ADAMTS 13 deficiency may present as thrombotic thrombocytopenic purpura of pregnancy. Pregnant women with thrombotic thrombocytopenic purpura and especially with severe deficiency of ADAMTS13 levels require specific consideration regarding treatment and prophylaxis in subsequent pregnancies.