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Bihać, Bosnia and Herzegovina

Solakovic N.,Reanimatology and Intensive Care
Acta Medica Saliniana | Year: 2011

Background: Caudal block is today the world's most commonly performed regional technique in the child population. It was made in 1933 for the first time, in the last 30 years it survived its repopularization due to the changes in the approach to the ''surgical''pain at children. Aim: The aim of the paper is to show the experience achieved during the performance of the block in our institution. Patients and Methods: Twenty patients at the age from four months to eight years underwent a surgery procedure such as hernioplasty, orchidopexia, circumcision and uretheral reconstruction in the hypospadias. After the induction of the general anesthesia, the patients are applied 0,25% levobupivacain in the dose determined by the Armitage scheme. The time is measured after which it was postoperatively necessary to ordinate the analgetic, and the possible residual motor block was followed which was expressed in the Bromage scale. Results: The average time needed for the patients to be ''pain-free''was 370 ± 40 min, and the possible use of the analgesics postoperatively was significantly delayed. Residual motor block, 30 minutes after the surgery at only 2 patients, was 1 by Bromage (impossibility of the extension of the lower extremity at the level of the hips). Cases of the urinary retention were not reported. Conclusion: Caudal block is a method which provides an excellent, affordable and safe analgesia at children. © 2011 by Acta Medica Saliniana.

Mikecin L.,University of Maribor | Krizmaric M.,University of Maribor | Giljevic J.S.,Childrens Hospital Zagreb | Gjurasin M.,Childrens Hospital Zagreb | And 3 more authors.
Croatian Medical Journal | Year: 2013

Aim To determine the activity of pseudocholinesterase (PChE) in cerebrospinal fluid (CSF) and serum in children with solid central nervous system (CNS) tumor and to assess whether PChE activity could be a valid biomarker for solid CNS tumors in children. Methods The study and control group included 30 children each. Children in the study group had a solid CNS tumor, while those from the control group had never suffered from any tumor diseases. CSF and serum samples were collected from all participants and PChE activity was determined using the Ellman's spectrophotometric method. PChE activity in CSF was shown as a cerebrospinal fluid/serum ratio expressed in percentage, ie, PChE CSF/serum ratio. Receiver operating characteristic (ROC) curve was used to assess whether PChE activity can be used as a biomarker for identifying children with solid CNS tumors. Results Children with solid CNS tumor had significantly higher PChE activity in CSF and serum, as well as PChE CSF/serum ratio (P = 0.001). PChE CSF/serum ratio in the study group was 2.38% (interquartile range [IQR] 1.14-3.97) and 1.09% (IQR 0.95-1.45) in the control group. ROC curve analysis of PChE CSF/serum ratio resulted in an area under the curve (AUC) value of 0.76 (95% confidence interval [CI] 0.63-0.88) and a cut-off of 1.09. Twenty five of 29 patients with elevated PChE CSF/serum ratio had a tumor, corresponding to a sensitivity of 83% and a specificity of 53%. Conclusion PChE CSF/serum ratio may be used as a test or biomarker with good sensitivity for solid CNS tumors in children.

Glasnovic A.,Clinical Hospital Dubrava | Cvija H.,University of Zagreb | Stojic M.,Clinical Hospital Dubrava | Tudoric Eno I.,Reanimatology and Intensive Care | And 5 more authors.
NeuroImmunoModulation | Year: 2014

Objectives: Receptor for advanced glycation end products (RAGE) ligands/RAGE interactions have been proposed to have a pathogenic role in neuroinflammatory disorders. Our study aimed to assess changes in high-mobility group box (HMGB)1 and its receptor RAGE in peripheral blood (PBL) and cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS) at the disease onset compared with control subjects. Methods: PBL and CSF were collected from control subjects (n = 30) and MS patients (n = 27) at clinical onset. Soluble RAGE (sRAGE), HMGB1, S100 calcium-binding protein A12 (S100A12), interleukin (IL)-1β and tumor necrosis factor (TNF)- were measured in the CSF and plasma by enzyme-linked immunosorbent assay. Gene expression in PBL mononuclear cells (PBMCs) was detected by quantitative PCR for RAGE, HMGB1, S100A12 and several proinflammatory/immunoregulatory cytokines. Results: We found a significantly lower expression of IL-10 (p = 0.031) in the PBMCs of MS patients. The level of sRAGE in the CSF of MS patients was lower (p = 0.021), with the ability to discriminate between MS patients and control subjects. Moreover, PBMC gene expression for HMGB1 and S100A12 positively correlated with IL-6. Conclusions: Our study confirmed that the cytokine network is disturbed in PBL and CSF at MS clinical onset. The deregulated HMGB1/RAGE axis found in our study may present an early pathogenic event in MS, proposing sRAGE as a possible novel therapeutic strategy for MS treatment. © 2014 S. Karger AG, Basel.

Brborovic H.,University of Zagreb | Sklebar I.,Reanimatology and Intensive Care | Brborovic O.,University of Zagreb | Brumen V.,University of Zagreb | Mustajbegovic J.,University of Zagreb
Postgraduate Medical Journal | Year: 2014

Background The Hospital Survey on Patient Safety Culture (HSOPSC), originally developed in the USA, is used worldwide to assess patient safety culture in hospitals. A limited number of studies have provided data on psychometric properties outside of the US healthcare system. Our aim was to determine if all 12 dimensions of the US HSOPSC were applicable, valid and reliable to Croatian healthcare workers. Methods The study was conducted from September 2010 to April 2011. Questions were translated into Croatian and then translated back into English. The questionnaires (ie, the Croatian translation of the US HSOPSC) were distributed in unmarked envelopes along with a consent form to all the doctors and nurses in four Croatian hospitals. The responses were analyzed using explorative factor analyses, reliability testing, and confirmatory factor analyses. Results The study included 561 healthcare workers in four Croatian hospitals-a response rate of 32.69%. Our results are similar to the original US sample, but with some differences: 11 dimensions with acceptable reliability scores were identified by exploratory factor analysis compared with the original 12 in the US sample; five of 12 dimensions had a Cronbach's a higher than 0.7, suggesting a reasonable fit to the original US HSOPSC; the dimensions 'Staffing' and 'Organizational learning-continuous improvement' were found to have a Cronbach's a <0.6. The use of confirmatory factor analysis confirmed a good fit to the original US model. Conclusions Results show that the Croatian translation of the US HSOPSC is compatible in 11 of the original 12 dimensions. Results suggest that for the purposes of research in Croatia, the dimensions 'Staffing', 'Communication openness', and 'Organizational learning -continuous improvement' should be revised. For example, the use of question A7 ('We use more agency/ temporary staff than is best for patient care') in the context of European healthcare systems should be adapted or removed for the Croatian version of the US HSOPSC questionnaire.

Kogler J.,University of Zagreb | Peric M.,University of Zagreb | Hrabac P.,University of Zagreb | Bekavac-Misak V.,University of Zagreb | Karaman-Ilic M.,Reanimatology and Intensive Care
Signa Vitae | Year: 2016

Introduction. Thoracic surgery is associated with high levels of pain. Magnesium has antinociceptive effects in animal and human models of pain. Objectives. The aim of this randomized prospective study was to assess the effects of continuous epidural magnesium infusion during thoracic surgery on intraoperative sufentanil consumption and postoperative analgesic requirements during the first 48 hours after surgery. Materials and methods. Seventy patients were randomized into two groups of 35 patients: Group 1 (magnesium group) received an epidural with 10% magnesium sulfate (MgSO4) along with anesthetic drugs (midazolam, propofol, rocuronium, sufentanil, levobupivacain), and group 2 (control group) received an epidural with 0.9% sodium chloride (NaCl) solution along with anesthetic drugs intraoperatively. Postoperatively, group 1 patients were administered the 10% magnesium sulfate epidural in addition to a local anesthetic and opioid, whereas group 2 patients were administered the local anesthetic and opioid alone. Primary outcomes of the study were to determine the cumulative doses of intraoperatively administered sufentanil and cumulative doses of sufentanil and levobupivacaine administered during the first 48 h postoperatively. Secondary outcomes were a visual analog scale (VAS) score for rest and movement every 4 hours, level of sedation, cardiovascular, respiratory and neurological complications, incidence of postoperative shivering, nausea and vomiting and global patient satisfaction. Results. The cumulative sufentanil dose required intraoperatively was significantly lower in the magnesium group: 43.00 μg vs 56.3 μg (p = 0.001). VAS scores measured every 4 hours at rest and movement during the first 48 hours postoperatively, cumulative analgesic consumption, incidence of shivering, nausea and vomiting were significantly lower in the magnesium group. The global satisfaction score was significantly higher in the magnesium group (4.3 vs 3.7; p = 0.005). Conclusion. The addition of magnesium in the epidural mixture of sufentanil and levobupivacaine led to more efficient intraoperative and postoperative analgesia, lower sufentanil and levobupivacaine consumption, lower incidence of postoperative shivering, nausea and vomiting. Epidural with magnesium appears to be a useful adjunct to anesthetic drugs, which can exert positive effects on the course and outcome of thoracic surgery patients. © 2015 Signa Vitae. All rights reserved.

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