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Bulum T, Brkljačić N, Tičinović Ivančić A, Čavlović M, Prkačin I, Tomić M. In Association with Other Risk Factors, Smoking Is the Main Predictor for Lower Transcutaneous Oxygen Pressure in Type 2 Diabetes. Biomedicines 2024; 12:381. [PMID: 38397984 PMCID: PMC10886561 DOI: 10.3390/biomedicines12020381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) significantly increases the risk of peripheral artery disease (PAD), and diabetes is the leading cause of nontraumatic amputations. This study investigated the risk factors for transcutaneous oxygen pressure (TcPO2) in T2DM, a noninvasive method to quantify skin oxygenation and the underlying microvascular circulation. The study included 119 T2DM patients (91 male/28 female). TcPO2 measurements were conducted with the Tina TCM4 Series transcutaneous monitor (Radiometer, Copenhagen, Sweden) and skin electrodes. Patients with TcPO2 < 40 mmHg were younger (p = 0.001), had significantly higher systolic blood pressure (SBP) (p = 0.023), glycated hemoglobin (HbA1c) (p = 0.013), fasting plasma glucose (fPG) (p = 0.038), total cholesterol (p = 0.006), LDL cholesterol (p = 0.004), and had more frequent smoking habits (p = 0.001) than those with TcPO2 ≥ 40 mmHg. The main predictors for the TcPO2 value (R2 = 0.211) obtained via stepwise regression analysis were age, smoking, SBP, HbA1c, fPG, and total and LDL cholesterol. Among all the listed predictors, smoking, HbA1c, and LDL cholesterol were found to be the most significant, with negative parameter estimates of -3.051310 (p = 0.0007), -2.032018 (p = 0.0003), and -2.560353 (p = 0.0046). The results of our study suggest that in association with other risk factors, smoking is the main predictor for lower TcPO2 in T2DM.
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Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Neva Brkljačić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | | | - Maja Čavlović
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Internal Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Martina Tomić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
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Svaguša T, Šimić S, Grabant F, Kereš T, Čančarević O, Paić F, Grizelj D, Blivajs A, Bulum T, Prkačin I. Comparison of vitamin K and non-vitamin K oral anticoagulants and the bleeding frequency in the emergency department. High Blood Press Cardiovasc Prev 2024; 31:23-30. [PMID: 38190093 DOI: 10.1007/s40292-023-00616-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Safety studies of anticoagulant therapy have so far been conducted on many subjects in controlled conditions (i.e., clinically monitored) and demonstrated the noninferiority of new ones over old anticoagulant drugs. Data on the propositions for the presence of symptoms and signs of bleeding among various anticoagulants in the emergency department indicate that these data do not match the data published so far. AIM The aim of the study was to investigate the differences in the frequency of bleeding and bleeding-related symptoms as a reason for emergency department attendance in patients on anticoagulant therapy. METHODS The study included patients from the emergency department of University Hospital for one year, who were on anticoagulant therapy and who met the inclusion criteria. Out of a total of 595 patients, 409 were on warfarin (68.74%), and the rest were taking direct oral anticoagulants (DOAC): dabigatran 71 (11.93%), rivaroxaban 66 (11.09%) and apixaban 49 (8.23%). RESULTS Out of 409 patients taking warfarin, 34.4% were adequately anticoagulated with the frequency of bleeding 13.7%, while in 57.2% of patients, PT INR was higher than the reference values with the frequency of bleeding 15.0%. A comparison between all DOAC groups and adequately anticoagulated warfarin patients in the frequency of bleeding and bleeding-related symptoms as a reason for emergency attendance yielded a difference that was marginally statistically significant (Pearson Chi-Square = 7.554, p = 0.052). CONCLUSION Monitoring the frequency of bleeding and bleeding-related symptoms in patients on oral anticoagulant therapy as a reason for emergency department attendance may be a new safety and efficacy factor in real-life patient scenarios.
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Affiliation(s)
- Tomo Svaguša
- Department of Cardiovascular Diseases, University Hospital Dubrava, 10000, Zagreb, Croatia
| | - Stjepan Šimić
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, 10000, Zagreb, Croatia
| | - Filip Grabant
- School of Medicine, University of Zagreb, Dugi dol 4a, Zagreb, Croatia
| | - Tatjana Kereš
- School of Medicine, University of Zagreb, Dugi dol 4a, Zagreb, Croatia
- Department of Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Ognjen Čančarević
- Department of Cardiovascular Diseases, University Hospital Dubrava, 10000, Zagreb, Croatia
| | - Frane Paić
- School of Medicine, University of Zagreb, Dugi dol 4a, Zagreb, Croatia
| | - Danijela Grizelj
- Department of Cardiovascular Diseases, University Hospital Dubrava, 10000, Zagreb, Croatia
| | - Aleksandar Blivajs
- Department of Cardiovascular Diseases, University Hospital Dubrava, 10000, Zagreb, Croatia
| | - Tomislav Bulum
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, 10000, Zagreb, Croatia.
- School of Medicine, University of Zagreb, Dugi dol 4a, Zagreb, Croatia.
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, Dugi dol 4a, Zagreb, Croatia
- Department of Internal Medicine, University Hospital Merkur, Zagreb, Croatia
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Jelaković B, Perkov D, Barišić K, Bukal N, Gellineo L, Jelaković A, Josipović J, Prkačin I, Željković Vrkić T, Živko M. Renal Denervation in the Treatment of Resistant Hypertension and Difficult-to-Control Hypertension - Consensus Document of the Croatian Hypertension League - Croatian Society of Hypertension, Croatian Cardiac Society, Croatian Endovascular Initiative, Croatian Society for Diabetes and Metabolic Diseases, Croatian Renal Association, and Croatian Society of Family Physicians of the Croatian Medical Association. Vasc Health Risk Manag 2023; 19:805-826. [PMID: 38108022 PMCID: PMC10724019 DOI: 10.2147/vhrm.s422773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
Renal denervation (RDN) as a method of treating arterial hypertension (AH) was introduced in Croatia in 2012. A multidisciplinary team and a network of hospitals that diagnose and treat patients with severe forms of AH were established, and a very strict diagnostic-treatment algorithm was prepared. At monthly meetings patients with truly resistant hypertension who were candidates for RDN were discussed. According to the 2021 ESH position statement and 2023 ESH guidelines, RDN is considered an alternative and additional, not a competitive method of treating patients with various forms of AH which must be performed by following a structured procedure and the patient's preference should be considered. In view of the changes in the global scientific community, the Croatian Hypertension League brings this consensus document on RDN conducted with radiofrequency-based catheter, the only currently available method in Croatia. In this document, exclusion and inclusion criteria are shown, as well as three groups of patients in whom RDN could be considered. The new diagnostic-treatment algorithm is prepared and follow-up procedure is explained. In Croatia, RDN is reimbursed by the national insurance company, thus pharmacoeconomic analyses is also shown. Criteria required by an individual centre to be approved of RDN are listed, and plans for prospective research on RDN in Croatia, including the Croatian registry for RDN, are discussed.
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Affiliation(s)
- Bojan Jelaković
- School of Medicine University of Zagreb, Zagreb, Croatia
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dražen Perkov
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Klara Barišić
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nikolina Bukal
- Department of Internal Medicine, Nephrology and Pulmonology, General Hospital “Dr. J. Benčević”, Slavonski Brod, Croatia
| | - Lana Gellineo
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Jelaković
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Josipa Josipović
- Croatian Catholic University, Zagreb, Croatia
- Department of Nephrology and Dialysis, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Ingrid Prkačin
- Department for Emergency Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | | | - Marijana Živko
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - On the behalf of Task force for the Resistant Hypertension and Renal Denervation of the Croatian Hypertension League
- School of Medicine University of Zagreb, Zagreb, Croatia
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
- Department of Internal Medicine, Nephrology and Pulmonology, General Hospital “Dr. J. Benčević”, Slavonski Brod, Croatia
- Croatian Catholic University, Zagreb, Croatia
- Department of Nephrology and Dialysis, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- Department for Emergency Medicine, Clinical Hospital Merkur, Zagreb, Croatia
- Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
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Brajković A, Bićanić LA, Orehovački H, Prkačin I, Oliveira DRD, Mucalo I. Prescribers' approval rate of pharmacist-initiated interventions to optimise patients' clinical status of hypertension in the ambulatory care setting. Acta Pharm 2023; 73:723-734. [PMID: 38147475 DOI: 10.2478/acph-2023-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
This perspective, pre- and post-intervention study with a one-year follow-up primarily aimed to ascertain prescribers' approval rate of pharmacists' interventions and clinical status of hypertension following comprehensive medication management (CMM) intervention in the ambulatory care clinic. Between January 2018 and January 2022 overall 100 patients with hypertension and other comorbidities were referred to the CMM services at the Health Centre Zagreb - Centar (HCZC). Out of 275 interventions directed to prescribers, 73.1 % of interventions were approved, 12.4 % were rejected and 14.5 % were not reviewed. The percentage of patients with a blood pressure goal increased from 45 % at the initial consultation to 82.5 % at the patients' latest encounter (p < 0.001). The average number of drug therapy problems (DTPs) per patient totaled 3.53 ± 1.80, where 98 % of patients had one or more DTPs, 48 % had 4 or more DTPs, whereas 26 % had 5 or more DTPs. Sub-therapeutic dosage (32.6 %) and the need for additional drug therapy (30.9 %) were the two most commonly identified DTPs. These results reinforce the need to integrate pharmacy-led services in the primary care setting with the aim of improving patients' health outcomes.
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Affiliation(s)
- Andrea Brajković
- 1University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb Croatia
| | | | | | - Ingrid Prkačin
- 3Department of Internal Medicine School of Medicine, University of Zagreb, Merkur University Hospital Zagreb, Croatia
| | - Djenane Ramalho De Oliveira
- 4College of Pharmacy, Centre for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Iva Mucalo
- 1University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb Croatia
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Šimić S, Svaguša T, Grgurević I, Mustapić S, Žarak M, Prkačin I. Markers of cardiac injury in patients with liver cirrhosis. Croat Med J 2023; 64:362-373. [PMID: 37927191 PMCID: PMC10668036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Liver cirrhosis is an increasing public health problem and a major cause of morbidity and mortality. Accordingly, cirrhotic cardiomyopathy, a frequently underdiagnosed condition, is becoming a growing health problem. In the last 20 years, cardioselective biomarkers have been investigated for their diagnostic and prognostic properties for numerous conditions. The aim of this article is to review the literature on the relationship between the most commonly used cardioselective biomarkers (cardiac troponins I and T, N-terminal pro-B-type natriuretic peptide, brain natriuretic peptide, and heart-type fatty-acid binding protein) and the presence, functional stage, and clinical outcomes of liver cirrhosis. Elevated plasma levels of these biomarkers have been reported in patients with liver cirrhosis, and there is mounting evidence on their predictive value for clinical outcomes in this disease. In addition, elevated plasma levels of these biomarkers have been reported in patients before, during, and after liver transplantation, but in fewer studies. Due to their predictive value for clinical outcomes, we advocate the use of these markers in patients with liver cirrhosis and cirrhotic cardiomyopathy, as well as in candidates for liver transplant.
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Affiliation(s)
| | - Tomo Svaguša
- Tomo Svaguša, Department of Cardiovascular Disease, Dubrava University Hospital, Avenija Gojka Šuška 6, 10 000 Zagreb, Croatia,
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Delalić Đ, Brežni T, Prkačin I. Diagnostic value and utility of commonly used biomarkers of cardiac and renal function in cardiorenal syndromes: a narrative review. Biochem Med (Zagreb) 2023; 33:030502. [PMID: 37545695 PMCID: PMC10373058 DOI: 10.11613/bm.2023.030502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Cardiorenal syndrome (CRS), first defined in 2004 as a consequence of the interactions between the kidneys and other circulatory departments leading to acute heart failure, has since been recognized as a complex clinical entity that is hard to define, diagnose and classify. The framework for the classification of CRS according to pathophysiologic background was laid out in 2008, dividing CRS into five distinct phenotypes. However, determining the timing of individual organ injuries and making a diagnosis of either renal or cardiac failure remains an elusive task. In clinical practice, the diagnosis and phenotyping of CRS is mostly based on using laboratory biomarkers in order to directly or indirectly estimate the degree of end-organ functional decline. Therefore, a well-educated clinician should be aware of the effects that the reduction of renal and cardiac function has on the diagnostic and predictive value and properties of the most commonly used biomarkers (e.g. troponins, N-terminal pro-brain natriuretic peptide, serum creatinine etc). They should also be acquainted, on a basic level, with emerging biomarkers that are specific to either the degree of glomerular integrity (cystatin C) or tubular injury (neutrophil gelatinase-associated lipocalin). This narrative review aims to provide a scoping overview of the different roles that biomarkers play in both the diagnosis of CRS and the prognosis of the disease in patients who have been diagnosed with it, along with highlighting the most important pitfalls in their interpretation in the context of impaired renal and/or cardiac function.
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Affiliation(s)
- Điđi Delalić
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tanja Brežni
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ingrid Prkačin
- University of Zagreb School of Medicine, Zagreb, Croatia
- Emergency Internal Medicine Clinic, Clinical Hospital Merkur, Zagreb, Croatia
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Raos D, Prkačin I, Delalić Đ, Bulum T, Lovrić Benčić M, Jug J. Postoperative Hyperuricemia-A Risk Factor in Elective Cardiosurgical Patients. Metabolites 2023; 13:metabo13050590. [PMID: 37233631 DOI: 10.3390/metabo13050590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Hyperuricemia is a well-known cardiovascular risk factor. The aim of our study was to investigate the connection between postoperative hyperuricemia and poor outcomes after elective cardiac surgery compared to patients without postoperative hyperuricemia. In this retrospective study, a total of 227 patients after elective cardiac surgery were divided into two groups: 42 patients with postoperative hyperuricemia (mean age 65.14 ± 8.9 years) and a second group of 185 patients without it (mean age 62.67 ± 7.45 years). The time spent on mechanical ventilation (hours) and in the intensive care unit (days) were taken as the primary outcome measures while the secondary measure comprised postoperative complications. The preoperative patient characteristics were similar. Most of the patients were men. The EuroSCORE value of assessing the risk was not different between the groups nor the comorbidities. Among the most common comorbidities was hypertension, seen in 66% of all patients (69% in patients with postoperative hyperuricemia and 63.7% in those without it). A group of patients with postoperative hyperuricemia had a prolonged time of treatment in the intensive care unit (p = 0.03), as well as a prolonged duration of mechanical ventilation (p < 0.01) and a significantly higher incidence of the following postoperative complications: circulatory instability and/or low cardiac output syndrome (LCOS) (χ2 = 4486, p < 0.01), renal failure and/or continuous venovenous hemodiafiltration (CVVHDF's) (χ2 = 10,241, p < 0.001), and mortality (χ2 = 5.22, p < 0.01). Compared to patients without postoperative hyperuricemia, elective cardiac patients with postoperative hyperuricemia have prolonged postoperative treatment in intensive care units, extended durations of mechanically assisted ventilation, and a higher incidence of postoperative circulatory instability, renal failure, and death.
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Affiliation(s)
- Dominik Raos
- Institute of Emergency Medicine of Zagreb County, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Internal Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Điđi Delalić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Bulum
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology, and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Martina Lovrić Benčić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department for Ischemic Heart Disease, University Clinic of Cardiovascular Diseases, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Juraj Jug
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Center Zagreb-West, 10000 Zagreb, Croatia
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Jug J, Delalić Đ, Bralić Lang V, Bulum T, Prkačin I. Prediabetes, Non-Dipping Profile and Hypertension—A Recipe for Increased Arterial Stiffness. Biomedicines 2023; 11:biomedicines11041065. [PMID: 37189683 DOI: 10.3390/biomedicines11041065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Background: Pulse wave velocity (PWV) is a known predictor of target organ damage, cardiovascular disease and overall mortality. The aim of this study was to compare the PWV values in subjects with prediabetes, a non-dipper profile and arterial hypertension with their values in healthy subjects. Methods: A total of 301 subjects, aged 40–70 years, without diabetes mellitus were included in this cross-sectional study (150 with prediabetes). They underwent a 24 h ambulatory blood pressure monitoring (ABPM). Subjects were divided into three hypertension groups (A = healthy, B = controlled hypertension, C = uncontrolled hypertension). Dipping status was determined according to ABPM results, and PWV was measured by an oscillometric device. Prediabetes was defined as having 2 separate fasting plasma glucose (FPG) measurements between 5.6 and 6.9 mmol/L. Results: The highest PWV values were found in group C (9.60 ± 1.34 vs. 8.46 ± 1.01 in group B vs. 7.79 ± 1.10 in group A; p < 0.001), in subjects with prediabetes (8.98 ± 1.31 m/s vs. 8.26 ± 1.22 m/s; p < 0.001) and in prediabetic non-dippers among age groups (p = 0.05). In the multivariate regression model age, blood pressure, nocturnal indices and FPG were shown as independent predictors of PWV values. Conclusion: Significantly higher PWV values were found in subjects with prediabetes and non-dipping profiles in all three examined hypertension groups.
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Affiliation(s)
- Juraj Jug
- Health Center Zagreb-West, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Điđi Delalić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Valerija Bralić Lang
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Family medicine practice Valerija Bralić Lang, 10000 Zagreb, Croatia
| | - Tomislav Bulum
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Internal E.R., Merkur University Hospital, 10000 Zagreb, Croatia
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Važanić D, Prkačin I, Nesek-Adam V, Kurtović B, Rotim C. OUT-OF-HOSPITAL CARDIAC ARREST OUTCOMES - BYSTANDER CARDIOPULMONARY RESUSCITATION RATE IMPROVEMENT. Acta Clin Croat 2022; 61:265-272. [PMID: 36818936 PMCID: PMC9934036 DOI: 10.20471/acc.2022.61.02.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 02/10/2023] Open
Abstract
Approximately 8000 people suffer from an out-of-hospital cardiac arrest (OHCA) in the Republic of Croatia every year. OHCA survival rates generally remain low despite major advances in resuscitation. Its incidence and survival rate are well known in many European countries, but reliable data on OHCA in Croatia are lacking. The aim of the study was to determine survival rate of patients with OHCA in the Republic of Croatia and the importance of the community bystander cardiopulmonary resuscitation (CPR) rates in the survival chain. This prospective observational study performed between October 1, 2017 and December 31, 2017 included all adult patients with OHCA in Croatia who were treated by Emergency Medical Services (EMS). OHCA data were collected from the Croatian Institute of Emergency Medicine database and Utstein cardiac arrest data collection form. Descriptive data presentation was used in the analyses. Data were expressed as absolute frequencies and percentages and central tendency measures. Testing of correlations in return of spontaneous circulation (ROSC) was performed by logistic regression. During the observation period, a total of 1763 adult patients without signs of circulation were assessed by EMS in Croatia and 760 (43%) adult patients were resuscitated by EMS personnel. Outcomes measured in ROSC until emergency department admission were reported in 126 (17%) cases. Shockable rhythm vs. non-shockable rhythm (OR: 5.832, 95% CI: 3.621-9.392; p<0.001) and bystander witnessed cardiac arrest (OR: 8.213, 95% CI: 2.554-26.411, p<0.001) were significantly associated with a higher probability of survival. There was no significant difference in correlation with day or night shift, etiology of cardiac arrest and bystander CPR variables. Survival rate of OHCA patients who received CPR until emergency department admission in Croatia was 17%. A higher survival rate post-OHCA was more likely among patients who received bystander CPR and had shockable rhythm.
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Affiliation(s)
- Damir Važanić
- Croatian Institute for Emergency Medicine, Zagreb, Croatia;,Catholic University of Croatia, Zagreb, Croatia;,University of Applied Health Sciences, Zagreb, Croatia
| | - Ingrid Prkačin
- Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia;,University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Višnja Nesek-Adam
- Department for Anesthesiology, Resuscitation and Intensive Care, Sveti Duh University Hospital, Zagreb, Croatia;,Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | | | - Cecilija Rotim
- University of Applied Health Sciences, Zagreb, Croatia;,Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
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Bulum T, Tomić M, Vrabec R, Martinović Bošković M, Ljubić S, Prkačin I. BLOOD PRESSURE IS ASSOCIATED
WITH DIABETIC RETINOPATHY
IN TYPE 1 BUT NOT IN TYPE 2 DIABETES. Acta Clin Croat 2022; 61:14-22. [PMID: 36304808 PMCID: PMC9536160 DOI: 10.20471/acc.2022.61.s1.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to investigate the role of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the development of diabetic retinopathy (DR) in type 1 and type 2 diabetes and to determine the differences between these two types of diabetes. This cross-sectional study included 84 patients with type 1 diabetes (T1DM) and 107 patients with type 2 diabetes (T2DM). Ophthalmologic retinal examination included indirect slit-lamp fundoscopy, color fundus photography according to EURODIAB (EUROpe and DIABetes) protocol and optical coherence tomography. Blood pressure was measured with a mercury sphygmomanometer after a 10-minute rest period. In T1DM, DR was positively associated with SBP (p = 0.035), HbA1cmedian (p < 0.001) and hypertensive retinopathy (p < 0.001), while in T2DM DR was positively related only to HbA1cmedian (p = 0.021). Binary logistic regression analysis (no DR/DR) showed that diabetes duration and HbA1cmedian were the main predictors of DR in both types of diabetes. In contrast, SBP (OR = 1.05, p = 0.045) and hypertensive retinopathy (OR = 3.75, p < 0.001) were the main predictors/indicators of DR only in T1DM. In conclusion, blood pressure is associated with DR in type 1 but not in type 2 diabetes.
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Delalić Đ, Roher R, Mileta D, Prkačin I. SYSTEMIC INFECTION WITH SINGLE OR MULTI-ORGAN DAMAGE CAUSED BY INADEQUATELY MANAGED CHRONIC WOUNDS: A CASE SERIES. Acta Clin Croat 2022; 61:49-52. [PMID: 36304799 PMCID: PMC9536163 DOI: 10.20471/acc.2022.61.s1.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chronic wounds are often underestimated condition with increasingly growing inpatient and outpatient treatment costs. Since the patient population affected by chronic wounds is heterogeneous and includes diabetes, chronic venous insufficiency and peripheral artery disease patients, with additional differences in gender, age, previous medical history, treatment of chronic wounds is highly personalized and dependent on a variety of factors. This paper aims to highlight the problems that the chronic wound patient population is facing during the COVID-19 pandemic: from higher probability of an undesirable disease outcome to the fact that many of them have limited access to primary care providers and to the regular and continuous care that their condition demands. This paper describe three patients with chronic wounds. Each of the patients had a significant worsening of their chronic wounds during the COVID-19 pandemic: either following an active SARS-CoV-2 infection or due to the limited access to primary care. The cases described here highlight the necessity of providing proper and regular care for all patients during the COVID-19 pandemic, regardless of the current state of the healthcare system and the adversities and hurdles it currently faces, to prevent the pandemic from becoming a syndemic.
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Affiliation(s)
- Điđi Delalić
- Medical School, University of Zagreb, Zagreb, Croatia
| | | | | | - Ingrid Prkačin
- Medical School, University of Zagreb, Zagreb, Croatia;,Merkur University Hospital, Zagreb, Croatia
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12
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Delalić Đ, Jug J, Prkačin I. ARTERIAL HYPERTENSION FOLLOWING COVID-19:
A RETROSPECTIVE STUDY OF PATIENTS
IN A CENTRAL EUROPEAN TERTIARY CARE CENTER. Acta Clin Croat 2022; 61:23-27. [PMID: 36304797 PMCID: PMC9536154 DOI: 10.20471/acc.2022.61.s1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to determine the frequency of newly verified or worsened existing hypertension in patients who had coronavirus 2019 (COVID-19). To be categorized as a COVID-19 patient, a positive reverse-transcription polymerase chain reaction test at a single point in time was required. The patients’ age, history, laboratory values and antihypertensive therapy of patients were recorded. In one year, 32 of 199 patients studied had either newly verified (15) or worsened existing (17) arterial hypertension. Among those patients, the median time from a verified infection to the onset of symptoms was 3 months. When the patients were divided into groups, 4 were in the acute, 11 in the sub-acute, 8 in the chronic and 9 in the “long COVID” group. Compared to the rest of the study population, patients presenting with arterial hypertension had significantly higher systolic (median 141 mmHg vs 130 mmHg, p<0.001) and diastolic (median 93 mmHg vs 80 mmHg, p<0.001) blood pressure and were significantly younger (median 51 vs 59 years, p 0.032). Arterial hypertension following COVID-19, either newly verified or worsened existing, is a relatively common occurrence (16% of our patient pool), indicating that more effort should be directed at evaluating the blood pressure values of patients following COVID-19.
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Affiliation(s)
- Điđi Delalić
- Medical School, University of Zagreb, Zagreb, Croatia
| | | | - Ingrid Prkačin
- Medical School, University of Zagreb, Zagreb, Croatia;,Merkur University Hospital, Zagreb, Croatia
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13
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Delalić Đ, Borčić V, Prkačin I. CAN'T INTUBATE, CAN'T OXYGENATE:
A RARE CASE OF A DIFFICULT AIRWAY DUE TO NONHEREDITARY ANGIOEDEMA. Acta Clin Croat 2022; 61:99-103. [PMID: 36304798 PMCID: PMC9536164 DOI: 10.20471/acc.2022.61.s1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Angioedema is a form of allergic mediated by histamine and non-allergic mediated by bradykinin and can be lethal if not recognized and treated promptly. This case demonstrates the proper diagnosis of and intervention in rapid onset severe angioedema. A 68-year-old male came to the emergency department with a complaint of dyspnea that started two hours before. He had type II diabetes, chronic kidney disease and several different antihypertensive medications, including an ACE inhibitor for hypertension. During physical examination, the patient was hypertensive, tachycardic, tachypnoic, and edematous. During his stay in the ED he was treated with a combination of corticosteroids, antihistamines and epinephrine, but the patient’s edema and dyspnea worsened and his oxygen saturation started to deteriorate with a progression of skin edema. Intubation was not possible due to the large edema of the tongue, so a tracheotomy was done. An ampule of icatibant was administered and rapid regression of the edema, along with the stabilization of the patient’s vital signs, followed after five minutes. The patient was discharged home after five days with a recommendation of discontinuing the ACE inhibitor. While non-hereditary angioedema is not a rare condition, emergency physicians should be adequately educated about it.
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Affiliation(s)
- Điđi Delalić
- Medical School, University of Zagreb, Zagreb, Croatia
| | | | - Ingrid Prkačin
- Medical School, University of Zagreb, Zagreb, Croatia;,Merkur University Hospital, Zagreb, Croatia
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14
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Rošić D, Kočet N, Simić A, Prkačin I, Nesek Adam V. DIAGNOSIS OF PULMONARY EMBOLISM
IN THE EMERGENCY DEPARTMENT. Acta Clin Croat 2022; 61:33-37. [PMID: 36304801 PMCID: PMC9536153 DOI: 10.20471/acc.2022.61.s1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to determine the association of clinical presentation, the Wells scoring system and D-dimer values with MSCT pulmonary angiography. A case control study was conducted in the Emergency Department of the Clinical Hospital Sveti Duh throughout 2019. Patients with a referral diagnosis of a pulmonary embolism were included in the study. Patients were divided into two groups. The first group consisted of patients diagnosed with pulmonary embolism by MSCT pulmonary angiography or postmortem, and the second group consisted of patients excluded from pulmonary embolisms. For the Wells score, D-dimers, troponin, respiratory rate and peripheral blood oxygen saturation, statistically significant differences were found between groups of patients with confirmed or excluded pulmonary embolism (p <0.001). For heart rate, chest pain, syncope, and hemoptysis, no statistically significant differences were found between these two groups of patients. Deep venous thrombosis of the lower extremities was found by ultrasound in > 70% of patients with massive a pulmonary embolism. Pulmonary embolism was confirmed in all patients for whom a high risk was calculated according to the Wells score. In conclusion, a low degree of clinical probability (according to the Wells score), along with a normal concentration of D-dimer, are a sure strategy in excluding pulmonary embolism.
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Affiliation(s)
- Damir Rošić
- Institute of Emergency Medicine of Primorje – Gorski Kotar County,
The Medical School of the Catholic University of Croatia;
| | - Nikola Kočet
- Institute of Emergency Medicine of Varaždin County;
| | - Anđela Simić
- Institute of Emergency Medicine of Varaždin County;
| | - Ingrid Prkačin
- Emergency Department University Hospital Merkur, School of Medicine University of Zagreb;
| | - Višnja Nesek Adam
- Emergency Department Clinical Hospital Sveti Duh, School of Medicine J.J. Strossmayer University of Osijek
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15
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Perkov S, Filipčić Višković N, Lupis T, Matišić E, Radeljak A, Prkačin I, Kardum Paro M. W272 Role of the ionized magnesium in the early post-liver transplantation outcome. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Brajković A, Bosnar L, do Nascimento MMG, Prkačin I, Balenović A, Ramalho de Oliveira D, Mucalo I. Healthcare Utilisation and Clinical Outcomes in Older Cardiovascular Patients Receiving Comprehensive Medication Management Services: A Nonrandomised Clinical Study. Int J Environ Res Public Health 2022; 19:ijerph19052781. [PMID: 35270472 PMCID: PMC8910212 DOI: 10.3390/ijerph19052781] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
The objective of this study was to evaluate the impact of comprehensive medication management (CMM) services on healthcare utilisation and cardiovascular risk factors among older patients with established cardiovascular diseases (CVDs). This quasi-experimental study that was performed at the Croatian primary care ambulatory clinic included patients aged 65 to 80 years. Patients were divided into intervention (65 patients) and control groups (68 patients) and were followed-up for one year. Pharmacists provided face-to-face consultations to patients from the intervention group. Groups were compared with regards to the clinical parameters (blood pressure, HbA1c, LDL, TC) and healthcare utilisation (hospital admission, emergency visits, unplanned GP visits). The CMM intervention significantly improved systolic blood pressure (p = 0.038), diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison with the control group. Patients included in CMM services had statistically and clinically lower systolic (−9.02 mmHg, p < 0.001) and diastolic blood pressure (−4.99 mmHg, p < 0.001) at the end of the study. The number of hospital admissions and unplanned GPs visits were 3.35 (95% CI 1.16−10.00) and 2.34 (95% CI 1.52−3.57) times higher in the control group compared to the intervention group, respectively. This study demonstrated that pharmacists providing CMM services can significantly contribute to better clinical outcomes and lower healthcare utilisation, thus potentially contributing to total healthcare savings.
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Affiliation(s)
- Andrea Brajković
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia;
| | - Lorena Bosnar
- Health Care Centre Zagreb–Centre, 10000 Zagreb, Croatia;
| | - Mariana Martins Gonzaga do Nascimento
- College of Pharmacy, Centre for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte, Belo Horizonte 31270-901, Brazil; (M.M.G.d.N.); (D.R.d.O.)
| | - Ingrid Prkačin
- Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, 10000 Zagreb, Croatia;
| | | | - Djenane Ramalho de Oliveira
- College of Pharmacy, Centre for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte, Belo Horizonte 31270-901, Brazil; (M.M.G.d.N.); (D.R.d.O.)
| | - Iva Mucalo
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia;
- Correspondence:
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17
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Jug J, Kocman I, Prkačin I. Mechanical obstruction of the peritoneal catheter with ovarian fimbriae, case reports. Ren Replace Ther 2022. [DOI: 10.1186/s41100-021-00392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe number of treated patients with peritoneal dialysis accounts for 2.8% of all kidney replacement therapy methods and constantly decreases. Peritoneal dialysis should be the first choice as the kidney function replacement treatment method in a transplantation waiting period. Besides all other possible infectious and mechanical complications of peritoneal catheter placement and maintenance, mechanical obstruction by ovarian fimbriae is very rare but potentially dangerous. We present four clinical cases (women 32–56 years) of mechanical obstruction of the peritoneal catheter by ovarian fimbriae during 2012–2014 in Clinical Hospital Merkur, Zagreb, Croatia. We use a laparoscopic technique with Čala trocar for peritoneal catheter placement in the right part of the Douglas cavity using a double-cuff Tenckhoff straight catheter. In our cases, all described obstructions were on the right side of the abdominal cavity. Only one patient had a displaced catheter. This problem was described only in a few case reports in which were presented with fluid exchange difficulties or initial vaginal secretion which can be easily mistaken for urinary incontinence. Mechanical complications connected with a peritoneal catheter can be successfully solved with laparoscopy intervention, which includes the ovary fimbriae obstruction.
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18
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Ifko M, Tkalčić Švabek Ž, Friščić I, Kardum Paro MM, Prkačin I, Đerek L, Livun A, Skvarč M. Diagnostic validation of two SARS-CoV-2 immunochromatographic tests in Slovenian and Croatian hospitals. Croat Med J 2021; 62:513-517. [PMID: 34730892 PMCID: PMC8596480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/28/2021] [Indexed: 04/08/2024] Open
Abstract
AIM To diagnostically validate two point-of-care (POC) rapid antigen tests for SARS-CoV-2 by comparing their results with those of laboratory-based real-time polymerase chain reaction tests (RT-PCR). METHODS The study enrolled 455 patients from two Slovenian and two Croatian hospitals. The NADAL COVID-19 Ag Test (Nal von Minden, Moers, Germany) and ALLTEST COVID-19 Antigen Test (Hangzhou ALLTEST Biotech Co., Ltd, Hangzhou, China) were diagnostically validated in emergency care departments of two Slovenian hospitals, while only ALLTEST COVID-19 Antigen Test was validated in two Croatian hospitals. RESULTS The antigen test results were in very good agreement with the RT-PCR results (Cohen's Kappa between 0.747 and 0.891 for the NADAL COVID-19 and between 0.820 and 0.954 for the ALLTEST COVID-19). The NADAL COVID-19 Ag Test had the sensitivity between 66.67% and 92.31%, with a negative predictive value between 85.51% and 99.2%. The ALLTEST COVID-19 Antigen Test had the sensitivity between 81.39% and 91.11%, with a negative predictive value between 85.45% and 98.78%. CONCLUSION The antigen tests are practical and reliable screening assays for SARS CoV-2 in emergency care departments. Both antigen tests can be used as screening tests to reduce the number of patients waiting for RT-PCR results. Even more, they can be used to quickly isolate COVID-19 patients and reduce hospital transmissions.
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Affiliation(s)
- Martina Ifko
- Martina Ifko, Ulica Roberta Hvalca 2, 2000 Maribor, Slovenia,
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19
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Šavuk A, Svaguša T, Trkulja V, Radeljak A, Rudan D, Kudumija B, Doko S, Kovačević L, Pezić MM, Ćorić V, Matić I, Prkačin I. Effect of low-flux and high-flux dialysis membrane on plasma concentrations of cardiac troponin I. Biomark Med 2021; 15:1479-1486. [PMID: 34668400 DOI: 10.2217/bmm-2021-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Cardiac troponin I (cTnI) concentration stability during dialysis have not been fully elucidated. The aim is to evaluate the effect of a single dialysis session on plasma cTnI. Patients & methods: From 122 consecutive anuric adult patients (75 [61.5%] men, age 27-86 years, median 67) on chronic hemodialysis blood samples for cTnI measurement were taken before and after a dialysis. Results: Dialysis had no effect on high-flux membranes (geometric means ratio = 0.99, 0.94-1.05, df 119, t = -0.19, multiplicity adjusted p = 0.847), but cTnI levels were higher after dialysis in patients on low-flux membranes (geometric means ratio = 1.14, 1.02-1.27, df 119, t = 2.59, adjusted p = 0.021). Conclusion: Dialysis session using low-flux membranes might increase the plasma cTnI.
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Affiliation(s)
- Ana Šavuk
- Department of Nephrology & Dialysis, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Tomo Svaguša
- Department of Cardiovascular Diseases, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - Andrea Radeljak
- Department of Medical Biochemistry & Laboratory Medicine, Reference Center of The Ministry of Health of The Republic of Croatia for the Development & Application of Biological Reference Intervals for Medical Biochemical Tests, Merkur University Hospital, Zagreb, Croatia
| | - Diana Rudan
- Department of Cardiovascular Diseases, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - Slava Doko
- Public Health Centre Zagreb-East, Zagreb, Croatia
| | - Lucija Kovačević
- Department of Radiology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Mija M Pezić
- Department of Internal Medicine, General Hospital Vinkovci, Vinkovci, Croatia
| | - Valentina Ćorić
- Department of Internal Medicine, General Hospital Vinkovci, Vinkovci, Croatia
| | - Ivica Matić
- School of Nursing Mlinarska, Zagreb, Croatia
| | - Ingrid Prkačin
- Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
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20
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Ifko M, Tkalčić Švabek Ž, Friščić I, Paro MMK, Prkačin I, Đerek L, Livun A, Skvarč M. Diagnostic validation of two SARS-CoV-2 immunochromatographic tests in Slovenian and Croatian hospitals. Croat Med J 2021. [PMID: 34730892 PMCID: PMC8596480 DOI: 10.3325/cmj.2021.62.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim To diagnostically validate two point-of-care (POC) rapid antigen tests for SARS-CoV-2 by comparing their results with those of laboratory-based real-time polymerase chain reaction tests (RT-PCR). Methods The study enrolled 455 patients from two Slovenian and two Croatian hospitals. The NADAL COVID-19 Ag Test (Nal von Minden, Moers, Germany) and ALLTEST COVID-19 Antigen Test (Hangzhou ALLTEST Biotech Co., Ltd, Hangzhou, China) were diagnostically validated in emergency care departments of two Slovenian hospitals, while only ALLTEST COVID-19 Antigen Test was validated in two Croatian hospitals. Results The antigen test results were in very good agreement with the RT-PCR results (Cohen's Kappa between 0.747 and 0.891 for the NADAL COVID-19 and between 0.820 and 0.954 for the ALLTEST COVID-19). The NADAL COVID-19 Ag Test had the sensitivity between 66.67% and 92.31%, with a negative predictive value between 85.51% and 99.2%. The ALLTEST COVID-19 Antigen Test had the sensitivity between 81.39% and 91.11%, with a negative predictive value between 85.45% and 98.78%. Conclusion The antigen tests are practical and reliable screening assays for SARS CoV-2 in emergency care departments. Both antigen tests can be used as screening tests to reduce the number of patients waiting for RT-PCR results. Even more, they can be used to quickly isolate COVID-19 patients and reduce hospital transmissions.
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21
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Paštrović F, Okštajner PK, Vodanović M, Raos D, Jug J, Lovrić Benčić M, Prkačin I. The Role of Anxiolytics in Hypertensive Urgency Management. Psychiatr Danub 2020; 32:593-596. [PMID: 33212468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Current guidelines do not cover hypertensive urgency management in out-of-hospital setting. Main goal of this study was to evaluate the value of anxiolytic therapy in hypertensive urgencies. We analyzed data gathered by out-of-hospital unit set up during one year. Arterial hypertension was the primary diagnosis in 178 (6.11%) patients, of whom 144 had hypertensive urgency with mean SBP reduction 19.5±7.2%; control group 10.1±6.9%. Anxiolytic therapy was administered in 60% of patients in hypertensive urgency group, and they had a statistically significant greater SBP reduction (p=0.03) than patients who did not receive anxiolytic therapy. There is a place for anxiolytic therapy in hypertensive urgency management.
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Affiliation(s)
- Frane Paštrović
- Institute for Emergency Medicine of Zagreb County, Zagreb, Croatia
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22
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Potkonjak AM, Sabolović Rudman S, Nikolac Gabaj N, Kuna K, Košec V, Stanec Z, Zovak M, Tučkar N, Djaković I, Prkačin I, Svaguša T, Bakoš M. Urinary troponin concentration as a marker of cardiac damage in pregnancies complicated with preeclampsia. Med Hypotheses 2020; 144:110252. [PMID: 33254557 DOI: 10.1016/j.mehy.2020.110252] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022]
Abstract
Pregnant women with preeclampsia experience significant hemodynamic changes which lead to an increased myocardial workload. In response to increased demands in pregnancy, the heart muscle responds with ventricular remodeling process which involves cardiac muscle hypertrophy. Opposed to occurrence of eccentric ventricular hypertrophy in normal pregnancy, myocardial remodeling in a form of concentric hypertrophy will occur in pregnant patients with preeclampsia. Increased myocardial workload is manifested by an increased troponin release. As process of troponin degradation continue, filtration of degradation fragment through glomerular membrane occur, raising the possibility of it's detection in urine. Degradation fragments of troponin molecules are estimated to be 20 kDa with preserved immunoreactivity to high-sensitivity assays. Some of the authors suggest that serum levels of cardiac troponin I might be elevated in patients with hypertension, as well as in preeclamptic pregnant women. It is to be expected that evaluation of severity of the myocardial damage in pregnant woman with preeclampsia may be performed by measuring levels of troponin in the urine using high-sensitivity assays. Designing of urine dipstick will help to detect an early phase of myocardial involvement in preeclamptic pregnancies.
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Affiliation(s)
- Ana Meyra Potkonjak
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
| | - Senka Sabolović Rudman
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- University Department of Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Krunoslav Kuna
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vesna Košec
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Zdenko Stanec
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Mario Zovak
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Neven Tučkar
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivka Djaković
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ingrid Prkačin
- Department of Internal Medicine, University Hospital Merkur, Zagreb, Croatia
| | - Tomo Svaguša
- Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Matija Bakoš
- Department of Paediatrics, University Hospital Centre Zagreb, Croatia
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Šimić S, Svaguša T, Prkačin I, Bulum T. Relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. J Diabetes Metab Disord 2020; 18:693-704. [PMID: 31890693 DOI: 10.1007/s40200-019-00460-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022]
Abstract
Objectives Diabetes mellitus is a group of metabolic disorders associated with high risk for cardiovascular disease. Although troponins are primarily clinically used for the diagnosis of acute coronary syndrome, they are also used in risk assessment in patients with acute coronary syndrome as well as in a number of other conditions. The aim of this review was to investigate the relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. Methods Hemoglobin A1c has been chosen as the best clinical indicator of glucose control and risk of micro and macrovascular complications. We investigated cardiac troponins as a group of markers of muscle injury which includes troponin T, troponin I and troponin C. Troponin T and I are specific for myocardial injury, compared to C which is specific for skeletal muscle. Results In this review, we showed that there was a causal relation between hemoglobin A1c levels and serum troponin concentrations. Hemoglobin A1c has shown to be a positive predictive factor of incidence, mortality and morbidity of conditions such as acute coronary syndrome, arrhythmias, stroke, pulmonary embolism and other conditions that causes troponin elevation by its release in circulation. Conclusions Chronic hyperglycemia decreases glomerular filtration and consequently decreases troponin elimination and also by affecting the heart microcirculation it leads to microvascular damage and consequently to ischemia which contribute to troponin concentration elevation. Furthermore, correlation between hemoglobin A1c and troponin concentration manifests in their prognostic value for mortality.
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Affiliation(s)
- Stjepan Šimić
- 1School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Tomo Svaguša
- 1School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- 2Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Ingrid Prkačin
- 1School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- 3Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Tomislav Bulum
- 1School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- 4Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
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Cavrić G, Prkačin I, Nassabain K, Vučković M, Bartolek Hamp D, Njerš K. High doses of vasoactive drugs in treatment of refractory septic shock in elderly patient. Gazz Med Ital - Arch Sci Med 2019. [DOI: 10.23736/s0393-3660.18.03919-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Perkov S, Ivić M, Taradi I, Knotek M, Prkačin I, Paro MK. Role of laboratory in management severe hypomagnesemia with associated hypocalcemia and hypokalemia after renal transplantation: A case report. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Karadža-Lapić L, Barešić M, Vrsalović R, Ivković-Jureković I, Sršen S, Prkačin I, Rijavec M, Cikojević D. HEREDITARY ANGIOEDEMA DUE TO C1-INHIBITOR DEFICIENCY IN PEDIATRIC PATIENTS IN CROATIA - FIRST NATIONAL STUDY, DIAGNOSTIC AND PROPHYLACTIC CHALLENGES. Acta Clin Croat 2019; 58:139-146. [PMID: 31363336 PMCID: PMC6629194 DOI: 10.20471/acc.2019.58.01.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare autosomal dominant disease with deficiency (type I) or dysfunction (type II) of C1 inhibitor, caused by mutations in the C1-INH gene, characterized by recurrent submucosal or subcutaneous edemas including skin swelling, abdominal pain and life-threatening episodes of upper airway obstruction. The aim of this study was to investigate healthcare experiences in children with HAE due to C1 inhibitor deficiency (C1-INH-HAE) in Croatia in order to estimate the number of affected children and to recommend management protocols for diagnosis, short-term prophylaxis and acute treatment. Patients were recruited during a 4-year period at five hospitals in Croatia. Complement testing was performed in patients with a positive family history. This pilot study revealed nine pediatric patients positive for C1-INH- HAE type I, aged 1-16 years, four of them asymptomatic. Before the age of one year, C1-INH levels may be lower than in adults; it is advisable to confirm C1-INH-HAE after the age of one year. Plasma-derived C1-INH is recommended as acute and short-term prophylactic treatment. Recombinant C1-INH and icatibant are licensed for the acute treatment of pediatric patients. In Croatia, HAE is still underdiagnosed in pediatric population.
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Affiliation(s)
| | - Marko Barešić
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Renata Vrsalović
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Irena Ivković-Jureković
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Saša Sršen
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Ingrid Prkačin
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Matija Rijavec
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
| | - Draško Cikojević
- 1Department of Otorhinolaryngology, Šibenik General Hospital, Šibenik, Croatia; 2Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Zagreb Children's Hospital, Zagreb, Croatia; Pediatric Department, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 6Department of Internal Medicine, School of Medicine, University of Zagreb, Merkur University Hospital, Zagreb, Croatia; 7Golnik University Clinic of Pulmonary and Allergic Diseases, Golnik, Slovenia; 8Department of Otorhinolaryngology, Split University Hospital Centre, Split, Croatia
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Karadža-Lapić L, Pikivaca T, Pervan P, Jović Zlatović J, Delin S, Prkačin I. The Incidence and Frequency of Various Causes of Angioedema in Emergency Medicine. Acta Med Acad 2018; 47:11-17. [PMID: 29957967 DOI: 10.5644/ama2006-124.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/04/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Angioedema (AE) is a potentially life-threatening event. We investigated the etiology of AE, with the emphasis on bradykinininduced angioedema treatment in emergency medicine. METHODS The retrospective study included 237 patients with AE, who were examined and treated in two hospitals (group A and B) in Croatia from 2009 to 2016. The location and duration of AE, data about chronic diseases and treatment, potential causative agents (food, drugs, insect bites and chemicals), physical examination data and the subsequent treatment were analyzed. RESULTS There was no statistical difference regarding age or comorbidities but there was a statistically significant difference in etiology between the groups (Chi-square, P=0.03). Renin-angiotensin-aldosterone system (RAAS) blocker induced AE was the main cause of emergency attendance in group A (37.5%) and among the leading causes in group B (18.8%). Bradykinin-induced AE (hereditary angioedema (HAE) and RAAS-AE) were the leading causes in a total of 75 (31.5%) patients. RAAS-AE was treated with glucocorticoids and antihistamines. HAE attacks in both groups (2/7 patients, 1.5/6%) were treated with specific therapy. Other causes of AE in groups A/B were insect bites (15/23 patients, 13.5/20%), use of antibiotics/analgetics (11/17 patients, 9/15%), gastroesophageal reflux disease (10/11 patients, 8/9%), neoplasms (5/6 patients, 4/5%) and idiopatic (32/31 patients, 26.5/26%). 21% of patients were hospitalized. CONCLUSION Bradykinin-mediated AE was the main cause of emergency attendance associated with AE. Advances in the treatment of HAE, with case reports of patients with RAAS-AE treated with C1 esterase inhibitor concentrate or bradykinin receptor antagonist, may prove to be a new, reliable and efficacious therapy option.
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Affiliation(s)
| | - Tamara Pikivaca
- University of Zagreb, School of Medicine Zagreb, Zagreb, Croatia; Public Health Centre Zagreb, Zagreb, Croatia
| | - Petra Pervan
- University of Zagreb, School of Medicine Zagreb, Zagreb, Croatia; Public Health Centre Zagreb, Zagreb, Croatia
| | | | - Sanja Delin
- Department of Pediatric, General Hospital Zadar, Zadar, Croatia
| | - Ingrid Prkačin
- University of Zagreb, School of Medicine Zagreb, Zagreb, Croatia; Clinical Hospital Merkur, Department of Internal Medicine/Emergency Unit, Zagreb, Croatia
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Cavrić G, Prkačin I, Perkov S, Nassabain K, Vučković M, Bartolek Hamp D. Rhabdomyolysis in a patient with chronic uncontrolled diabetes mellitus and hypothyroidism. Gazz Med Ital - Arch Sci Med 2018. [DOI: 10.23736/s0393-3660.17.03527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pervan P, Svaguša T, Prkačin I, Savuk A, Bakos M, Perkov S. Urine high sensitive Troponin I measuring in patients with hypertension. SIGNA VITAE 2017. [DOI: 10.22514/sv133.062017.13] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Flegar-Meštrić Z, Perkov S, Radeljak A, Kardum Paro MM, Prkačin I, Devčić-Jeras A. Risk analysis of the preanalytical process based on quality indicators data. Clin Chem Lab Med 2017; 55:368-377. [PMID: 27580180 DOI: 10.1515/cclm-2016-0235] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/20/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Improving quality and patient safety in the medical biochemistry laboratory accredited according to the International Standard Organization (ISO 15189:2012) requires the patient-centered evaluation of errors based on the implementation of quality indicators (QIs) across the total testing process. Our main goal was to achieve quality improvement of the preanalytical process in an emergency laboratory which had the highest error rate using risk management principles. METHODS Failure mode and effects analysis (FMEA) was applied to analyze predefined preanalytical QIs and score laboratory failures for the failure demerit value (FDV), probability of failure (PF) and probability of failure remedy (PFR). Based on obtained scores (on a 10-point scale) risk priority numbers (RPNs) were calculated. RESULTS A total of five failure modes were identified in the preanalytic process. The calculated risks were "sample hemolysis" (RPN, 168),"misidentified samples" (RPN, 108),"samples clotted" (RPN, 90),"sample volume error" (RPN, 72) and "samples transported at inappropriate temperature" (RPN, 24). The activation of corrective risk-reducing measures for failure modes with RPN≥30 resulted in quality improvement with the significant decrease in reevaluated RPNs. CONCLUSIONS The implementation of a preanalytical quality monitoring system based on observation of evidence-based QIs and patient-centered evaluation of errors through risk analysis with regular tailored education as well as implementing process improvements can effectively reduce preanalytical errors in the emergency laboratory and improve patient safety.
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Bulum T, Prkačin I, Duvnjak L. MP444TREATMENT WITH A GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST EXENATIDE DECREASES ALBUMINURIA IN OVERWEIGHT TYPE 2 DIABETIC PATIENTS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw193.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Prkačin I, Bulum T, Vrhovec B, Šambula L, Legović A, Radočaj T. MP280A NEW ORAL ANTICOAGULANT THERAPY IN PATIENTS WITH NONDIALYSIS CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw188.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Bulum T, Prkačin I, Duvnjak L. SP385HIGH PREVALENCE OF NONPROLIFERATIVE RETINOPATHY IN NORMOALBUMINURIC PATIENTS WITH TYPE 1 DIABETES. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw169.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hamp DB, Cavrić G, Prkačin I, Houra K, Perović D, Ljubičić T, Elezović A. [DEVICE-ASSOCIATED HEALTHCARE INFECTION AND SEPSIS IN INTENSIVE CARE UNIT]. Acta Med Croatica 2015; 69:203-209. [PMID: 29077378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The incidence of healthcare-associated infections and sepsis (HAIs) is 5-10 times higher in patients in intensive care units (ICUs) than in those at other hospital departments. Predisposition for these lies in many intrinsic (disease severity, loss of immunity) and extrinsic factors (frequent use of broad-spectrum antibiotics with consequent presence of antibiotic-resistant pathogens). The majority of HAIs in ICUs are associated with the use of invasive devices (DA-HAIs; device-associated healthcare-associated infections) (19%). Their incidence differs among specific types of ICUs (2%-49%). The most frequent DA-HAI are central line-associated bloodstream infections (CLA-BSI), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI) and surgical site infections (SSI). SSI is most often described as a distinct and separate entity of HAIs in ICUs. Recently, gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter spp.) are more frequently isolated in DA-HAIs than gram-positive ones (Staphylococcus aureus, Enterococcus spp.), often present as resistant strains. On the other hand, urinary or/and systemic infections tend to increase. DA-HAIs endanger and slow down patient recovery, prolong hospital stay, and generally increase the mortality rate. DA-HAIs are of special interest of the Hospital Committee Center for Infective Disease in order to improve patient safety and reduce total cost allocated for prevention of DA-HAIs. DA-HAI rate is the most useful intra- and inter-hospital measure to compare surveillance and effectiveness of preventive procedures among different ICU types.
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Cavrić G, Nassabain K, Prkačin I, Hamp DB. [SOMETHING ABOUT DEFINITION AND EPIDEMIOLOGY OF SEPSIS]. Acta Med Croatica 2015; 69:125-134. [PMID: 29077366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The prevalence of sepsis continues to increase, although, thanks to the efforts of the campaigns and the development of guidelines for sepsis treatment, the fatality rates have diminished, however, the sepsis total mortality is growing due to increased morbidity. Sepsis should be considered as an emergency almost similar to acute myocardial infarction. With regard to the high prevalence and high mortality rate, it is important to improve the definition of sepsis. This definition is also important in different researches, as well as in the application of the results in daily practice. In January 2014, at the 43rd Annual Congress of Society of Critical Care Medicine in San Francisco, the work on establishing a new definition of sepsis was started. New definition of sepsis probably would represent what is known today as severe sepsis. The new definition could probably be accomplished during 2015.
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Prkačin I, Cavrić G, Bartolek-Hamp D. [MANAGEMENT OF ADULT SEPTIC PATIENT IN EMERGENCY UNIT]. Acta Med Croatica 2015; 69:221-224. [PMID: 29077381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Early identification of sepsis is crucial to improve patient outcomes. Yet, sepsis can be difficult to differentiate in Emergency Unit. Sepsis treatment includes fluid resuscitation as soon as possible, starting with >1000 mL of crystalloids or 500 mL of colloids for 30 min. Acute kidney injury is a serious complication of sepsis, associated with increased mortality, prolonged hospital stay and increased cost of care. In patients with sepsis, it would be useful to have some biomarkers of early organ damage, to improve the capacity for early recognition and diagnosis of acute kidney injury.
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Bulum T, Blaslov K, Prkačin I, Zibar K, Duvnjak L. SP474TREATMENT WITH A GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST LIRAGLUTIDE DECREASES ALBUMINURIA IN OVERWEIGHT TYPE 2 DIABETIC PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv195.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kos I, Prkačin I. [DIABETIC NEPHROPATHY AS A CAUSE OF CHRONIC KIDNEY DISEASE]. Acta Med Croatica 2014; 68:375-381. [PMID: 26285470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Diabetic nephropathy is the leading cause of end-stage chronic kidney disease in most developed countries. Hyperglycemia, hypertension and genetic predisposition are the main risk factors for the development of diabetic nephropathy. Elevated serum lipids, smoking habits, and the amount and origin of dietary protein also seem to play a role as risk factors. Clinical picture includes a progressive increase in albuminuria, decline in glomerular filtration, hypertension, and a high risk of cardiovascular morbidity and mortality. Screening for albuminuria should be performed yearly, starting 5 years after diagnosis in type 1 diabetes or earlier in the presence of adolescence or poor metabolic control. In patients with type 2 diabetes, screening should be performed at diagnosis and yearly thereafter. Patients with albuminuria should undergo evaluation regarding the presence of associated comorbidities, especially retinopathy and macrovascular disease. Achieving the best metabolic control (HbA1c < 7%), treating hypertension (target blood pressure < 140/85 mm Hg), using drugs with blockade effect on the renin-angiotensin-aldosterone system, treating dyslipidemia and anemia are effective strategies for preventing the development of albuminuria, delaying the progression to more advanced stages of nephropathy and reducing cardiovascular mortality in patients with type 1 and type 2 diabetes.
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Rački S, Bašić-Jukić N, Kes P, Ljutić D, Lovčić V, Prkačin I, Radić J, Vujičić B, Bubić I, Jakić M, Belavić Ž, Sefer S, Pehai M, Klarić D, Gulin M. [Treatment of anemia in chronic kidney disease--position statement of the Croatian Society for Nephrology, Dialysis and Transplantation and review of the KDIGO and ERPB guidelines]. Acta Med Croatica 2014; 68:215-221. [PMID: 26012163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Renal anemia is the result of chronic kidney disease (CKD) and deteriorates with disease progression. Anemia may be the first sign of kidney disease. In all patients with anemia and CKD, diagnostic evaluation is required. Prior to diagnosing renal anemia, it is necessary to eliminate the other possible causes. Direct correlation between the concentration of hemoglobin and the stage of renal failure is well known. Early development of anemia is common in diabetic patients. Correction of anemia may slow the progression of CKD. Anemia is an independent risk factor for developing cardiovascular disease in patients with CKD. Treatment of anemia in patients with CKD is based on current guidelines. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group has produced comprehensive clinical practice guidelines for the management of anemia in CKD patients and ERBP (European Renal Best Practice) group its position statement and comments on the KDIGO guidelines. The Croatian Society of Nephrology, Dialysis and Transplantation (HDNDT) has already published its own guidelines based on the recommendations and positive experience of European and international professional societies, as well as on own experience. The latest version of Croatian guidelines was published in 2008. Since then, on the basis of research and clinical practice, there have been numerous changes in the modern understanding of the treatment of anemia in CKD. Consequently, HDNDT hereby publishes a review of the recent recommendations of international professional societies, expressing the attitude about treating anemia in CKD as a basis for new guidelines tailored to the present time.
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Klarić D, Prkačin I. [Assisted peritoneal dialysis]. Acta Med Croatica 2014; 68:91-95. [PMID: 26012144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
According to the National Registry of Renal Replacement Therapy (RRT), the incidence of chronic kidney disease (end-stage renal disease) and the need of RRT have declined in the last decade renal. One of the reasons for this tendency certainly is transplantation as the best choice. However, transplant procedure has limitations in elderly patients due to the number of comorbidities. This study was designed as retrospective analysis of outcomes in patients treated with peritoneal dialysis for a period of eleven years. Patients were divided into those who had been assisted or unassisted. Out of 100 patients treated with peritoneal dialysis (PD), 77 completed the treatment, including 26 assisted and 51 unassisted patients. Peritonitis was recorded in 20 assisted and 26 unassisted patients. Peritonitis was more common in unassisted patients, who were more frequently lost from PD. Assisted PD could be a good and safe choice of RRT in this special group of patients.
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Prkačin I, Balenovic D, Cavrić G, Bartolek D, Bulum T. [Importance of standardized stepwise screening in patients with resistant hypertension]. Acta Med Croatica 2014; 68:111-115. [PMID: 26012147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Resistant hypertension (RH) is a condition that confers a high cardiovascular risk to the patient due to both persistent blood pressure elevation and the high prevalence of comorbidities and organ damage. Hypertension is defined as resistant (RH) to treatment when a therapeutic strategy that includes appropriate lifestyle measures plus a diuretic and two other antihypertensive drugs belonging to different classes at adequate doses fails to lower blood pressure (BP) values to < 140 and 90 mm Hg, respectively. Prior to diagnosing a patient as having RH, it is important to document adherence and exclude white-coat hypertension, inaccurate measurement of BP, and secondary causes. Ambulatory BP monitoring (ABPM) has become an important tool in the diagnosis and follow-up of hypertensive patient, and it is even more important in the evaluation of those with resistant RH. Among patients with RH, it is very important to select patients with standardized stepwise screening: ABPM of resistant hypertensives has a circadian profile with a high proportion of nondipping. The possible reasons for the absence of dipping are sleep disturbance, obstructive sleep apnea, obesity, high salt intake in salt-sensitive subjects, orthostatic hypotension, autonomic dysfunction, chronic kidney disease, diabetic neuropathy, and old age. It seems reasonable to routinely use ABPM in the initial evaluation of all resistant hypertensive patients. In a significant number of these patients, ABPM will also be an essential tool in follow-up, especially regarding the possible effects of all therapeutic maneuvers that are devoted to bringing BP into the target ranges. The potential success of other therapeutic options such as renal denervation depends on the ability to select patients most likely to benefit.
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Prkačin I, Cavrić G, Počanić D, Leder N, Vidjak V. [Resistant hypertension and reasons for excluding patients from treatment with renal denervation]. Acta Med Croatica 2014; 68:117-120. [PMID: 26012148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Increased activation of the sympathetic nervous system is identified as an important factor in the development and progression of hypertension. In this context, a catheter-based approach has been developed to disrupt the renal sympathetic nerves, i.e. renal denervation. Among patients with resistant hypertension, it is very important to select patients using standardized stepwise screening. The potential success of renal denervation depends on the ability to select patients most likely to benefit. A multidisciplinary meeting in necessary. In this work, we describe the potential reasons for excluding patients from treatment with renal denervation.
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Bašić-Jukić N, Rački S, Kes P, Ljutić D, Vujičić B, Lovčić V, Orlić L, Prkačin I, Radić J, Jakić M, Klarić D, Gulin M. [How to prevent protein-energy wasting in patients with chronic kidney disease--position statement of the Croatian Society of Nephrology, Dialysis and Transplantation]. Acta Med Croatica 2014; 68:191-199. [PMID: 26012159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Protein-energy wasting (PEW) is a frequent problem in patients with end-stage renal disease, which is associated with adverse outcome. Risk factors for development of PEW in dialysis patients include anorexia, limitations in food intake due to problems with mineral metabolism (hyperphosphatemia, hyperkalemia). Prevention of PEW in dialysis population demands different therapeutic measures to correct abnormalities and to prevent loss of energy and proteins. Therapeutic approach should be individualized based on the specific problems of each patient in order to correct metabolic problems and to optimize food intake. In patients with inability to maintain nutritional status with standard oral feeding, other measures which include oral nutrition supplements and intradialytic parenteral feeding should be applied. Anabolic steroids, growth hormone and adequate oral nutritional supplements, together with physical activity may prevent further catabolism and correct abnormalities. Appetite stimulators, antiinflammatory interventions and anabolic drugs seem promising; however, their efficacy should be investigated in future clinical trials.
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Bulum T, Duvnjak L, Prkačin I. 351 RELATIONSHIP BETWEEN INSULIN SENSITIVITY AND LIPID PROFILE IN EUTHYROID TYPE 1 DIABETIC PATIENTS. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bulum T, Duvnjak L, Prkačin I. 583 IMPACT OF CIGARETTE SMOKING ON SERUM LIPIDS IN TYPE 1 DIABETES MELLITUS. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Bulum T, Prkačin I, Duvnjak L. 233 RELATIONSHIP BETWEEN ALBUMINURIA AND SERUM LIPIDS IN TYPE 1 DIABETES MELLITUS. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bulum T, Prkačin I, Vujanić D, Knotek M. MS340 IMMUNOSUPPRESSIVE AND ANTI-DYSLIPIDEMIC TREATMENT AFTER KIDNEY AND KIDNEY–PANCREAS TRANSPLANTATION. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70841-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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