AIM Moderate to severe asthma patients with sufficient and insufficient vitamin D serum level, respectively, were assessed with quality of life questionnaires before and after treatment with vitamin D added to their standard asthma treatment. METHODS Patients with moderate to severe asthma have been divided into two groups based on a serum level of vitamin D as sufficient or insufficient level of vitamin D, respectively. During 12 months, a total of 120 patients with sufficient level of vitamin D as well as 120 patients with insufficient level were given treatment with 2000 IU vitamin D for a three-month period. Quality of life of all patients was assessed by Asthma Control Test (ACT), Asthma Quality of Life (AQOL) and the physician's assessment expressed through the Global Evaluation of Treatment Effectiveness (GETE), which were performed before and after the treatment with Vitamin D. RESULTS Values of ACT and AQOL were higher after the treatment with vitamin D in both groups of patients. Values of GETE were lower after the treatment with vitamin D in both groups. All assessed components, psychological, physical, as well as the subjective feeling of control of the disease assessed by treating physicians, showed improvement after treatment. CONCLUSION Adding vitamin D in the treatment regimen of moderate to severe asthma patients improves quality of life and general asthma treatment effectiveness.
Background: Aortic stenosis (AS) is the most common form of valvular disease in the elderly population, with degenerative calcified valves remaining the primary cause of this condition. Due to the progressive nature of the disease, a significant reduction in aortic valve area leads to increased left ventricular (LV) pressure overload, resulting in adaptive but ultimately maladaptive concentric hypertrophy and progressive myocardial remodeling. Objective: The main objectives of the study were to assess the regression of left ventricular (LV) hypertrophy, Methods: This retrospective study included 150 patients who underwent surgical aortic valve replacement (AVR) with the Sorin Freedom Solo (SFS) stentless bioprosthesis and the St. Jude Regent (STJ) mechanical valve. Patients were divided into three groups based on follow-up duration: six months, one year, and two years. changes in transvalvular gradient, perioperative outcomes, and survival rates. Results: The results showed a significant reduction in the transvalvular gradient for both valves (p < 0.0001), with a more pronounced decrease in patients with the SFS valve. The thickness of the interventricular septum (IVS) continuously decreased in SFS patients across all groups, whereas a significant reduction was observed only in Group 2 for STJ valves. Left ventricular ejection fraction (LVEF) showed a significantly greater increase in patients with the SFS valve (p < 0.024), particularly in Group 2. Overall mortality was 5.30% for STJ valves and 6.66% for SFS valves, with no statistically significant differences in Kaplan–Meier survival analysis (p > 0.05). Conclusion: The SFS valve demonstrated superior hemodynamic performance and more pronounced LV hypertrophy regression, making it a suitable option for high-risk patients. The STJ valve ensures stable long-term function and remains the preferred choice for younger patients with acceptable operative risk. These findings highlight the importance of a personalized approach in selecting valvular prostheses.
BACKGROUND Both phases of euthyroid sick syndrome (ESS) are associated with worse prognosis in septic shock patients. Although there are still no indications for supplementation therapy, there is no evidence that both phases (initial and prolonged) are adaptive or that only prolonged is maladaptive and requires supplementation. AIM To analyze clinical, hemodynamic and laboratory differences in two groups of septic shock patients with ESS. METHODS A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups. The analysis included demographic data, mortality scores, intensive care unit stay, mechanical ventilation length and 28-day survival and laboratory with hemodynamics. RESULTS The Simplified Acute Physiology Score II score (P = 0.029), dobutamine (P = 0.003) and epinephrine requirement (P = 0.000) and the incidence of renal failure and multiple organ failure (MOF) (P = 0.000) were significantly higher for the low T3T4. Hypoalbuminemia (P = 0.047), neutrophilia (P = 0.038), lymphopenia (P = 0.013) and lactatemia (P = 0.013) were more pronounced on T2 for the low T3T4 group compared to the low T3 group. Diastolic blood pressure at T0 (P = 0.017) and T1 (P = 0.007), as well as mean arterial pressure at T0 (P = 0.037) and T2 (P = 0.033) was higher for the low T3 group. CONCLUSION The low T3T4 population is associated with higher frequency of renal insufficiency and MOF, with worse laboratory and hemodynamic parameters. These findings suggest potentially maladaptive changes in the chronic phase of septic shock.
Background: Autoimmune limbic encephalitis (ALE) is an inflammatory brain process involving a group of diseases with antibodies against neuronal synaptic and cellular antigens. Diagnosis is based on clinical examination, neurological functional tests, cerebrospinal fluid analysis, immunological testing, and radiological findings. Objective: This case report aims to present the case of a 68-year-old patient initially hospitalized for intermittent neurological deficits in the form of cognitive disorders of consciousness, which was initially declared as dementia without physical neurological deficit. Case presentation: Initial brain MRI (SIEMENS Magnetom Avanto, 1.5 T, Erlangen, Germany) showed changes differentially diagnosed characterised as glial neoplasm of mixed-grade astrocytoma or inflammatory process of unilateral autoimmune encephalitis. Since the neurosurgical opinion suggested a higher-grade glioma with proposed surgical treatment, the patient was referred for repeated MRI with MR spectroscopy in order to exhaust all diagnostic possibilities before surgery. MRI with MR spectroscopy (SIEMENS Magnetom Lumina, 3 T, Erlangen, Germany) revealed radiologically altered findings, in the right hippocampus and parahippocampal gyrus, which primarily corresponded to changes due to unilateral autoimmune encephalitis,due to its morphology characteristics and spectroscopy profile, making the primary glial neoplasm of lower grade less likely. Since the neurological mosaic IIFT result showed a positive LGI1 antibody finding, therapy for autoimmune encephalitis was initiated, leading to significant improvement in cognitive functions and the return of short-term memory. Conclusion: Although the detection of antibodies against onconeural, cellular, and synaptic proteins represents a significant advancement in diagnosing autoimmune limbic encephalitis, the role of conventional diagnostic tools such as MRI, EEG, and cerebrospinal fluid analysis should not be overlooked, where the application of new functional imaging techniques such as MR spectroscopy can be beneficial and should be considered.
Case report : Severe mitral regurgitation due to rupture of the chordae tendineae and mitral valve pro-lapse (Barlow’s disease), with a left atrial volume of 37.6 mL/m 2 was verified in 43-year old patient. He was admitted for an examination due to frequent palpitations and fast and irregular heartbeats. In the anamnestic data, thrombosis of the veins of the right leg was verified (thrombosis of popliteal, posterior tibial and great saphenous vein during previous years). He carries mutations: heterozygote of factor V Leiden, with MTHFR C677T heterozygote (CT), PAI- 1 heterozygote (4G⁄5G) and MTHFR A1298C heterozygote. The surgical treatment was done, and mechanical valve was implanted. In the follow-ing months, the patient complained on frequent dizziness, with crises of consciousness, and a short-ness of breath. He was not suitable for beta-blocker therapy, as well as propafenone and amiodarone, which had been prescribed in therapy in the meantime. The 24-hour ECG Holter monitoring described various arrhythmias, most of the time AV block of the first degree with PQ interval up to 320 msec, oc-casionally second-degree atrioventricular block Mobitz II, polymorphic ventricular extrasystoles and one attack of non-sustained ventricular tachycardia (6 ventricular extrasystoles in row), with intermit-tent nodal rhythm, junctional tachycardia and atrial flutter with AV ratio 2:1. An electrophysiological study was performed, and the cavotricuspid isthmus (CTI) dependent atrial flutter was verified, and radiofrequent ablation was done. After the procedure patient was in sinus rhythm. During the next follow up visits, the patient was in sinus rhythm, on therapy with a low dose of nebivolol (inability to tolerate beta blockers) and ivabradine, along with vitamin K antagonists. Conclusion
Background: Acute respiratory distress syndrome (ARDS) is life treating condition, with intensive general inflammation. Objective: Inflammation can be present with infection or without. Septic embolism, according to our previous experience, is more often multiple, than single. General hypoxia of hall body cause damage of all tissue, and generalinflammationintensifies. A vicious circle was formed and inflammation runs its course in what is very often irrelevant how it was begun.How often pulmonary embolism causes ARDS and what are the main features of this disease, is the goal of the study. Methods: Patients with ARDS, treated in pulmonary intensive care unit were analyzed. Chest X-ray, microbiological analysis of sputum or bronchoalveolar lavage specimen, chest CT scan, blood culture, CRP (mg/dl), deep-dimmer and blood cell count, were performed for all cases. Results: In three years period 53 patients with ARDS were treated. Out of all 19 with septic pulmonary embolism (14 multiple), (CRP 198±28). In only 12 patients origin of venous thrombus was found. Out of all 6 patients have massive non septic embolism (CRP 28±7), 18 heavy pneumonia (CRP 166±28), 4 with interstitial pneumonia (CRP 76±19), 5 with massive TB with caverns (CRP 35±13) and 6 with not well defined cause. Blood culture was positive in 14 cases with septic embolism and in 11 cases with pneumonia. CRP was elevated in all cases but highest was in septic embolism (Mann-Whitney test p=0,024). Conclusion: Septic pulmonary embolism was common cause of ARDS, mostly as multiple, and should be considered even if origin of thrombus was found or not.
Introduction: According to the World Health Organization estimates annually in the world die due to CVI every sixth women and 10th man. This paper is the research of the correlation between changes in relative air humidity and stroke (CVA) in the Sarajevo Canton. Included are patients who experienced an acute stroke in the Canton of Sarajevo and treated in the pre hospital phase by the staff of the Institute for Emergency Medicine. Days with stroke and those without cases of stroke were compared within three years and meteorological data for those days were obtained by the Weather Bureau of Federation of Bosnia and Herzegovina. Meteorological data include measurements of average humidity every day at 7, 14 and 21 o’clock in three years. Aim: To evaluate the significance of the influence of humidity on the incidence of CVI’s. Show the trend towards CVI in the reporting period and is it correlated with the trend of change in relative humidity in those days. Correlate the incidence of stroke as determined in relation to gender, age and selected climatic parameter. Material and Methods: This article presents a retrospective study. Subjects were patients of Emergency Medical Care Institute in Sarajevo, which in the period from 2004 to 2006 had a CVI. Included are patients who had a working diagnosis of stroke for the first time or as a repeated stroke. Analysis of cases of stroke was carried out by gender, age, days and seasons by descriptive-analytical epidemiological methods. Results: In total were registered 1930 patients during three years period. According to years of research in 2004–635, 2005-616 and 2006 – 679. It was found that when testing the null hypothesis about the effects of humidity in two months with a maximum stroke in the year and days without CVI and relative humidity only in 2005 had a statistically significant effect on the incidence of stroke, while during the other two years of the study there was no impacts. It turned out that the extreme values of relative humidity of the day whether there was a rapid increase or decrees in humidity increases the incidence of stroke in all three years of research. Conclusion: Patients gender had no effect on the incidence of CVI. Seasons had no effect on the incidence of CVI. Most CVI in all three years of research was in relation to the old age and occurred in the older age group 70-79 (41.35%), where it was shown that the age of the patient influences the incidence of CVI. Extremely low relative humidity and extremely high, influence on the increase in the number of CVI. Determined is a slight correlation between the average relative humidity and CVI in single day.
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