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Intermittent chemotherapy and erlotinib for nonsmokers or light smokers with advanced adenocarcinoma of the lung
Matjaž Zwitter, Mirjana Rajer, Viljem Kovač, Izidor Kern, Martina Vrankar, Uroš Smrdel, 2011, izvirni znanstveni članek

Opis: Background. Intermittent application of chemotherapy and tyrosine kinase inhibitors may avoid antagonism between the two classes of drugs. This hypothesis was tested in a Phase II clinical trial. Patients and Methods. Eligible patients were nonsmokers or light smokers, chemo-naïve, with metastatic adenocarcinoma of the lung. Treatment: 4 to 6 cycles of gemcitabine 1250 mg/m2 on days 1 and 4, cisplatin 75 mg/m2 on day 2, and erlotnib 150 mg daily on days 5–15, followed by erlotinib as maintenance. Results. 24 patients entered the trial. Four pts had grade 3 toxicity. Complete remission (CR) and partial remission (PR) were seen in 5 pts and 9 pts, respectively (response rate 58%). Median time to progression (TTP) was 13.4 months and median overall survival (OS) was 23 months. When compared to patients with negative or unknown status of EGFR mutations, 8 patients with EGFR gene activating mutations had significantly superior experience: 4 CR and 4 PR, with median TTP 21.5 months and OS 24.2 months (P < .05). Conclusions. Intermittent schedule with gemcitabine, cisplatin and erlotinib has mild toxicity. For patients who are positive for EGFR gene activating mutations, this treatment offers excellent response rate, time to progression and survival.
Ključne besede: smokers, nonsmokers, cancer treatment, lung cancer, chemotherapy, erlotinib
Objavljeno: 14.06.2017; Ogledov: 47; Prenosov: 0
.pdf Polno besedilo (2,30 MB)

Single nucleotide polymorphisms as prognostic and predictive factors of adjuvant chemotherapy in colorectal cancer of stages I and II
Matej Horvat, Uroš Potočnik, Katja Repnik, Rajko Kavalar, Borut Štabuc, 2016, pregledni znanstveni članek

Opis: Colorectal cancer (CRC) is a highly heterogeneous disease regarding the stage at time of diagnosis and there is special attention regarding adjuvant chemotherapy in unselected patients with stage I and stage II. The clinicohistologically based TNM staging system with emphasis on histological evaluation of primary tumor and resected regional lymph nodes remains the standard of staging, but it has restricted sensitivity resulting in false downward stage migration. Molecular characteristics might predispose tumors to a worse prognosis and identification of those enables identifying patients with high risk of disease recurrence. Suitable predictive markers also enable choosing the most appropriate therapy. The current challenge facing adjuvant chemotherapy in stages I and II CRC is choosing patients with the highest risk of disease recurrence who are going to derive most benefit without facing unnecessary adverse effects. Single nucleotide polymorphisms (SNPs) are one of the potential molecular markers that might help us identify patients with unfavorable prognostic factors regarding disease initiation and recurrence and could determine selection of an appropriate chemotherapy regimen in the adjuvant and metastatic setting. In this paper, we discuss SNPs of genes involved in the multistep processes of cancerogenesis, metastasis, and the metabolism of chemotherapy that might prove clinically significant.
Ključne besede: single nucleotide polymorphism, colorectal cancer, adjuvant chemotherapy
Objavljeno: 14.06.2017; Ogledov: 27; Prenosov: 0
.pdf Polno besedilo (1,27 MB)

Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with recurrent variceal hemorrhage
Peter Popović, Andrej Zore, Katarina Šurlan Popović, Manca Garbajs, Pavel Skok, 2013, izvirni znanstveni članek

Opis: Purpose.The purpose of this study was to determine the incidence and predictors of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy (ET) in the elective treatment of recurrent variceal hemorrhage. Methods. Seventy patients were treated with elective TIPS and fifty-six patients with ET. Median observation time was 46.28 months in the TIPS group and 42.31 months in the ET group. Results. 30 patients (42.8%) developed clinically evident portosystemic encephalopathy in TIPS group and 20 patients (35.6%) in ET group. The difference between the groups was not statistically significant (P=0.542; X2 test). The incidence of new or worsening portosystemic encephalopathy was 24.3% in TIPS group and 10.7% in ET group. Multivariate analysis showed that ET treatment (P=0.031), age of >65 years (P=0.022), pre-existing HE (P=0.045), and Childs class C (P=0.051) values were independent predictors for the occurrence of HE. Conclusions. Procedure related HE is a complication in a minority of patients treated with TIPS or ET. Patients with increased age, preexisting HE, and higher Child-Pugh score should be carefully observed after TIPS procedure because the risk of post-TIPS HE in these patients is higher.
Ključne besede: veins, dilated veins, rebleeding, portacaval encephalopathy, liver, cirrhosis, portal hypertension, transjugular intrahepatic portosystemic shunt
Objavljeno: 14.06.2017; Ogledov: 51; Prenosov: 0
.pdf Polno besedilo (1,18 MB)

Quantitative evaluation of growth plates around the knees of adolescent soccer players by diffusion-weighted magnetic resonance imaging
Zmago Krajnc, Mitja Rupreht, Matej Drobnič, 2015, izvirni znanstveni članek

Opis: Purpose. To quantitatively evaluate growth plates around the knees in adolescent soccer players utilizing the diffusion-weighted MR imaging (DWI). Methods. The knees and adjacent growth plates of eleven 14-year-old male soccer players were evaluated by MRI before (end of season´s summer break) and after two months of intense soccer training. MRI evaluation was conducted in coronal plane by PD-FSE and DWI. All images were screened for any major pathological changes. Later, central growth plate surface area (CGPSA) was measured and the apparent diffusion coefficient (ADC) values were calculated in two most central coronal slices divided into four regions: distal femur medial (DFM), distal femur lateral (DFL), proximal tibia medial (PTM), and proximal tibia lateral (PTL). Results. No gross pathology was diagnosed on MRI. CGPSA was not significantly reduced: DFM 278 versus 272, DFL 265 versus 261, PTM 193 versus 192, and PTL 214 versus 210. ADC decrease was statistically significant only for PTM: DFM 1.27 versus 1.22, DFL 1.37 versus 1.34, PTM 1.13 versus 1.03 (p=0.003), and PTL 1.28 versus 1.22. Conclusions. DWI measurements indicate increased cellularity in growth plates around knees in footballers most prominent in PTM after intense training. No detectable differences on a standard PD-FSE sequence were observed.
Ključne besede: soccer, adolescent, quantitative magnetic resonance, knee
Objavljeno: 14.06.2017; Ogledov: 35; Prenosov: 1
.pdf Polno besedilo (1,92 MB)

Predictors of mortality and prehospital monitoring limitations in blunt trauma patients
Vitka Vujanović, Tine Pelcl, Matej Strnad, Miljenko Križmarić, Vesna Borovnik Lesjak, 2015, izvirni znanstveni članek

Opis: This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients' charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n=40) and nonsurvivors (n=30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P=0.006), with lower initial GCS (P<0.001) and higher ISS (P<0.001), along with higher lactate (P<0.001) and larger base deficit (BD; P=0.006 ), whereas RTS (P=0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P<0.001), for ISS 0.82 (P<0.001), and for BD 0.69 (P=0.006). Lactate level of 3.4mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P=0.037), GCS (P=0.033), and age (P=0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P<0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.
Ključne besede: vital signs, nonsurvivors, survivors
Objavljeno: 14.06.2017; Ogledov: 29; Prenosov: 0
.pdf Polno besedilo (1,30 MB)

Usefulness of the patient information leaflet (PIL) and information on medicines from professionals
Tonka Poplas-Susič, Janko Kersnik, Zalika Klemenc-Ketiš, 2014, izvirni znanstveni članek

Opis: Background: The Patient information leaflet (PIL) is an important source of information for every patient. Little is known about whether patients read the PIL and whether it contains useful information. Other sources of drug-related information are professionals (a family practitioner, a pharmacist and a nurse). Informing patients on drugs improves their compliance. The aim of the study was to identify the usefulness of PIL from the perspective of the patient, to assess professionals as a source of drug-related information and to suggest changes that can improve informing and therefore patients' compliances. Methods: Four focus group interviews were conducted across different primary health care centres in the North East of Slovenia. Focus groups were composed of randomly selected patients (in total 20) who were willing to express their views on PILs, on other drug information sources and on possible improvements. A qualitative analysis of the data was based of the transcription of the audiotapes. Results: Patients read the PILs selectively. They were most interested in side effects, contraindications and the purpose of the prescribed drug. Participants reported that the language in PILs is too scientific. In the case they do not understand PILs or they recognise some of the side effects, a majority of participants decide to contact a family physician first, and less frequently a pharmacist or a nurse. A family physician is considered to be the most trustworthy source of information and patients think that pharmacists could play a more active role in patients% education. Conclusion: Current PILs offer enough partial information to patients but need some improvements in terms of better legibility and access to the most crucial information. PIL does not enable a comprehensive information with respect to patient%s health status. Most reliable source of information is considered to be a family practitioner. Pharmacists could play a more active role in the education of patients.
Ključne besede: PIL, focus groups, medicines, family practitioner
Objavljeno: 10.05.2017; Ogledov: 129; Prenosov: 0
.pdf Polno besedilo (91,61 KB)

Primerjava prednosti in slabosti takojšnje ter odložene prekinitve popkovnice pri novorojenčku
Tamara Todorović, Andraž Dovnik, Iztok Takač, 2015, pregledni znanstveni članek

Opis: Izhodišča: Prekinitev popkovnice pri novorojenčku je v porodništvu še vedno predmet raz- prav. Tako ločimo takojšnjo prekinitev popkovnice, ki se običajno izvede v prvih 10, 15, 30 ali celo 60 sekundah po rojstvu, in odloženo prekinitev popkovnice, ki običajno pomeni prekinitev popkovnice več kot 60 sekund ali 2–5 minut po rojstvu, ob prenehanju pulzacij popkovnice ali ob pojavu posteljice v porodnem kanalu. Takojšnja prekinitev popkovnice je ena od treh komponent aktivnega vodenja tretje porodne dobe, ki se je v modernem porodništvu uveljavilo v zadnjem stoletju, medtem ko je v nekaterih severnoevropskih državah ponekod v ZDA in Kanadi ter v razvijajočih se državah bolj aktualen fiziološki pristop. Zaključki: V zadnjih letih se takojšnja prekinitev popkovnice v številnih smernicah vse bolj zamenjuje z odloženo prekinitvijo, saj so raziskave potrdile številne prednosti slednje. Med najpomembnejšimi prednostmi odložene prekinitve popkovnice omenjajo višjo raven hemoglobina in feritina, večje zaloge železa, zmanjšano pojavnost anemije zaradi pomanjkanja železa, boljšo kardiopulmonalno prilagoditev in daljše trajanje zgodnjega dojenja pri donošenem novorojenčku ob nespremenjeni pojavnosti poporodne krvavitve pri materi. Prednosti odložene prekinitve popkovnice se kažejo tudi pri nedonošenčkih. Kljub vsemu je potrebna previdnost zaradi možnega pojava policitemije s hiperviskoznostjo, hiperbilirubinemije in dihalne stiske.
Ključne besede: prekinitev popkovnice, tretja porodna doba, anemija, pomanjkanje železa, poporodna krvavitev
Objavljeno: 10.05.2017; Ogledov: 136; Prenosov: 0
.pdf Polno besedilo (83,43 KB)

Pomen vodene razprave v simulacijah visoke stopnje posnemanja resničnosti
Igor Karnjuš, Miljenko Križmarić, Damjan Zazula, 2014, pregledni znanstveni članek

Opis: Vodena razprava (angl. debriefing) je najpomembnejši del učenja s simulacijami visoke stopnje posnemanja resničnosti, v kateri mentor pozove učeče se, da kritično ocenijo znanje in spretnosti, ki so jih pokazali med izvedbo scenarija. Kljub številnim raziskavam, ki proučujejo izobraževanje s simulacijami, je področje vodene razprave še razmeroma slabo opredeljeno. V prispevku so o sodobni literaturi povzete bistvene značilnosti vodene razprave, njene faze, tehnike in metode. Poudarjena je vloga mentorja, saj je učinkovitost vodene razrave v veliki meri odvisna ravno od njegove usposobljenosti. Podane so smernice, s katerimi mentor lahko oceni lastno uspešnost pri vodenju razprave. Prav tako je izpostavljen pomen pri kontinuiranem izobraževanju v kliničnem okolju, saj vodena razprava omogoča oceno uspešnosti izvedbe klinične obravnave in možnosti postavljanja novih strategij s ciljem doseči večjo usposobljenost zdravstvenega tima. Čeprav je vodena razprava temelj izobraževanja s simulacijami visoke stopnje posnemanja resničnosti, je tudi pomemben način učenja v kliničnem okolju. Mnogi vidiki vodene razprave so še vedno slabo raziskani, zato bo temu segmentu v prihodnosti potrebno nameniti večjo pozornost.
Ključne besede: vodena razprava, simulacije visoke stopnje posnemanja resničnosti, simulatorji bolnika, metode učenja, mentorji
Objavljeno: 10.05.2017; Ogledov: 81; Prenosov: 2
.pdf Polno besedilo (217,23 KB)

Non-invasive prenatal cell-free fetal DNA testing for down syndrome and other chromosomal abnormalities
Darija Strah, Petra Ovniček, Janez Bernik, 2015, izvirni znanstveni članek

Opis: Background: Chorionic villus sampling and amniocentesis as definitive diagnostic procedures represent a gold standard for prenatal diagnosis of chromosomal abnormalities. The methods are invasive and lead to a miscarriage and fetal loss in approximately 0.5–1 %. Non-invasive prenatal DNA testing (NIPT) is based on the analysis of cell-free fetal DNA from maternal blood. It rep- resents a highly accurate screening test for detecting the most common fetal chromosomal abnormalities. In our study we present the results of NIPT testing in the Diagnostic Center Strah, Slovenia, over the last 3 years. Methods: In our study, 123 pregnant women from 11th to 18th week of pregnancy were included. All of them had First trimester assessment of risk for trisomy 21, done before NIPT testing. Results: 5 of total 6 high-risk NIPT cases (including 3 cases of Down syndrome and 2 cases of Klinefelter’s syndrome) were confirmed by fetal karyotyping. One case–Edwards syndrome was false positive. Patau syndrome, triple X syndrome or Turner syndrome were not observed in any of the cases. Furthermore, there were no false negative cases reported. In general, NIPT testing had 100 % sensitivity (95 % confidence interval: 46.29 %–100.00 %) and 98.95 % specificity (95 % confidence interval: 93.44 %–99.95 %). In determining Down syndrome alone, specificity (95 % confidence interval: 95.25 %- 100.00 %) and sensitivity (95 % confidence interval: 31.00 %–100.00 %) turned out to be 100 %. In 2015, the average turnaround time for analysis was 8.3 days from the day when the sample was taken. Repeated blood sampling was required in 2 cases (redraw rate = 1.6 %). Conclusions: Our results confirm that NIPT rep- resents a fast, safe and highly accurate advanced screening test for most common chromosomal abnormalities. In current clinical practice, NIPT would significantly decrease the number of unnecessary invasive procedures and the rate of fetal loss caused by invasive diagnostics.
Ključne besede: non-invasive prenatal DNA testing, chromosomal abnormalities, Down syndrome, pregnancy, fetal DNA
Objavljeno: 10.05.2017; Ogledov: 94; Prenosov: 1
.pdf Polno besedilo (140,48 KB)

Načrtovan porod na domu
Tamara Todorović, Iztok Takač, 2016, pregledni znanstveni članek

Opis: Izhodišča: Porod na domu je sicer star toliko kot človeštvo, pa vendar v veliki večini srednje in visoko razvitih držav prevladuje mnenje, da so zaradi nepredvidljivosti zapletov porodnišnice najbolj varno okolje za rojevanje. Kljub temu obstaja peščica držav, v katerih je porod na domu integriran v sistem zdravstvenega varstva (npr. Nizozemska, Velika Britanija, Kanada). Pri porodih na domu ločimo nenačrtovane in načrtovane porode na domu, slednje pa lahko nadalje razdelimo še na porode s spremljevalcem in brez spremljevalca. V članku se bomo omejili na načrtovane porode na domu, ki pa so po svetu različno razširjeni. V Združenih državah Amerike se doma rodi 0,6–1,0 % vseh otrok, v Veliki Britaniji 2–3 %, v Kanadi 1,6 %, na Nizozemskem 20–30 %, v Avstriji in Nemčiji pa se zunaj porodnišnice rodi 1,3 % vseh otrok. Za Slovenijo število načrtovanih porodov na domu ni znano, se je pa leta 2010 pri nas 0,1 % otrok rodilo zunaj zdravstvene ustanove. Zaključki: Varnost načrtovanega poroda na domu je še vedno predmet razpravljanja. Medtem ko raziskave potrjujejo manjše število porodniških posegov in zapletov pri materah, ki rodijo doma, si podatki glede neonatalne in perinatalne umrljivosti in obolevnosti zelo nasprotujejo. To potrjuje potrebo po večjih multicentričnih raziskavah za to področje. Trenutne smernice poudarjajo predvsem dobro informiranost nosečnic glede možnih prednosti in slabosti poroda na domu in opredelitev izbirnih meril za porod na domu, indikacij za prevoz v porodnišnico med porodom ter ustrezno izobraženost porodnih spremljevalcev.
Ključne besede: porod na domu, maternalna umrljivost, perinatalna umrljivost, porodniški posegi
Objavljeno: 10.05.2017; Ogledov: 82; Prenosov: 2
.pdf Polno besedilo (96,39 KB)

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