Collegium antropologicum
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Collegium antropologicum · Dec 2009
Historical ArticleEvolution of management and investigations of cerebrovascular diseases in Croatia.
The author presents the history of management of cerebrovascular diseases (CVD) in Croatia since the beginning of medical health service in the country in the 19th and its evolution to the end of the 20th century. The foundation of the Zagreb School of Medicine in 1917 had paramount importance for the development of neurology, during the first period within the common specialty of neuropsychiatry. The interest for the CVD in Croatia became evident in the sixties of the past century, particularly when neurology has become a separate specialty in 1974. ⋯ The concept of comprehensive care for CVD patients was promoted, as a continuum of prevention, early treatment--if necessary in the ICU followed by modern rehabilitation. The described efforts were stopped due to the wars in the former Yugoslavia in the last decade of the 20th century. The process has been reinstated with new enthusiasm and new teams at the beginning of the 21st century after the postwar consolidation in Croatia and in the region.
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Collegium antropologicum · Sep 2009
Randomized Controlled Trial Comparative StudyMechanical ventilation in chronic obstructive pulmonary disease patients, noninvasive vs. invasive method (randomized prospective study).
Acute respiratory failure due to chronic obstructive pulmonary disease (COPD) presents an increasing problem throughout the world. The aim of this study was to compare invasive and non-invasive mechanical ventilation (MV) for patients with COPD. A prospective, randomized trial was performed in a multidisciplinary intensive care unit for the period of 36 months and included 156 patients with COPD. ⋯ MV duration NIM:IMV was 94:172 hours, p < 0.001, time spent in Intensive Care Unit 120:223 hours, p < 0.001. Ventilator associated pneumonia 5(6%):29(37%), p < 0.001. The advantage of NIMV in COPD patients, especially in the early stages was confirmed.
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Collegium antropologicum · Sep 2009
Correlation of APACHE II and SOFA scores with length of stay in various surgical intensive care units.
The aim of this study was to evaluate the usefulness of using Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score as the predictors of length of stay (LOS) in various surgical intensive care units (ICUs) and to test the hypothesis that the significance of scoring for predicting LOS is greater in specialized surgical ICUs. We scored patients in a non-specialized general surgical ICU (n = 328) and in a specialized cardiosurgical ICU (n = 158) consecutively on admission (APACHE II-1st day; SOFA-1st day) and on third day of stay (APACHE II-3rd day; SOFA-3rd day) in a 4-month period. LOS and APACHE II/SOFA scores were significantly correlated both on admission and on third day of stay in the general surgical ICU (APACHE II-1st day r = 0.289; SOFA-1st day r = 0.306; APACHE II-3rd day r = 0.728; SOFA-3rd day r = 0.725). ⋯ Usefulness of scoring for predicting LOS in ICU varied between different surgical ICUs. Contrary to our hypothesis, scoring had greater value for predicting LOS in the non-specialized general surgical ICU. APACHE II score on admission had no value for predicting LOS in the cardiosurgical ICU.
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Collegium antropologicum · Jun 2009
Acute stress and depression 3 days after vaginal delivery--observational, comparative study.
During the first month postpartum, 85% of women experience some form of mood disorders. The most common are: postpartum blues, non-psychotic postpartum depression, puerperal psychosis. Delivery of a child can be traumatic for some women. ⋯ A statistically significant difference has been found between the control (n=42) and the peripartal complications (n=61) groups in both the mean IES-R (4.67 +/- 5.43 and 13.50 +/- 14.12, respectively, p < 0.01) as well as in the mean EPDS (3.85 +/- 2.76 and 7.03 +/- 3.90, respectively, p < 0.01) scores. Additionally, while there were 4 cases of acute stress reactions and 3 cases of acute depressive state in the peripartal complications group there were no cases of these states in the control group. Based on our findings we conclude that using IES-R and EPDS questionnaires as early as three days after delivery could provide an early detection of previously healthy mothers with greater risk for development of postpartum psychiatric disorders.
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Collegium antropologicum · Jun 2009
Randomized Controlled TrialPerioperative management with glucose solution and insulin.
The objective of this study was to analyze how preoperative glucose treatment influences the blood glucose level as a measured exponent of surgical stress and to establish the best postoperative replacement considering glucose solutions and insulin. This prospective clinical trial involved 208 non-diabetic patients with normal glucose tolerance, who underwent major surgical procedures and needed 24 hours ICU monitoring postoperatively. Patients were randomly given 5% glucose solution (1000 mL) one day before surgery or after overnight fasting. ⋯ All data were processed with descriptive statistics, chi-square test, parametric ANOVA test and ANOVA test with repeated measure, non parametric Kruskal-Wallis test and Mann-Whitney U-test. Statistically significant change was accepted with p < 0.05. Preoperative glucose infusion decreased metabolic and endocrine response only during surgery; the smallest increase of postoperative blood glucose level was noticed after administering postoperative non-glucose crystalloid solutions; there is no clinical evidence that one specific postoperative replacement is better than the other; there is no clinical evidence that postoperative use of insulin can decrease or attenuate surgical induced insulin resistance.