1. Neurological outcome in patients after successful resuscitation in out-of-hospital settingsMartin Marinšek, Andreja Sinkovič, David Šuran, 2020, original scientific article Abstract: Neurological outcome is an important determinant of death in admitted survivors after out-of-hospital cardiac arrest (OHCA). Studies demonstrated several significant pre-hospital predictors of ischemic brain injury (time to resuscitation, time of resuscitation, and cause of OHCA). Our aim was to evaluate the relationship between post-resuscitation clinical parameters and neurological outcome in OHCA patients, when all recommended therapeutic strategies, including hypothermia, were on board. We retrospectively included consecutive 110 patients, admitted to the medical ICU after successful resuscitation due to OHCA. Neurological outcome was defined by cerebral performance category (CPC) scale I-V. CPC categories I-II defined good neurological outcome and CPC categories III-V severe ischemic brain injury. Therapeutic measures were aimed to achieve optimal circulation and oxygenation, early percutaneous coronary interventions (PCI) in acute coronary syndromes (ACS), and therapeutic hypothermia to improve survival and neurological outcome of OHCA patients. We observed good neurological outcome in 37.2% and severe ischemic brain injury in 62.7% of patients. Severe ischemic brain injury was associated significantly with known pre-hospital data (older age, cause of OHCA, and longer resuscitations), but also with increased admission lactate, in-hospital complications (involuntary muscular contractions/seizures, heart failure, cardiogenic shock, acute kidney injury, and mortality), and inotropic and vasopressor support. Good neurological outcome was associated with early PCI, dual antiplatelet therapy, and better survival. We conclude that in OHCA patients, post-resuscitation early PCI and dual antiplatelet therapy in ACS were significantly associated with good neurological outcome, but severe ischemic brain injury was associated with several in-hospital complications and the need for vasopressor and inotropic support.
Keywords: out-of-hospital cardiac arrest, OHCA, ischemic brain injury, resuscitation
Published in DKUM: 30.01.2025; Views: 0; Downloads: 2
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2. Overview of the efficacy of using probiotics for neurosurgical and potential neurosurgical patientsSabina Fijan, Tomaž Šmigoc, 2024, review article Abstract: This review delves into the emerging field of the gut microbiota-brain axis, emphasizing its bidirectional communication and implications for neurological health, particularly in trauma and neurosurgery. While disruptions in this axis can lead to dysbiosis and hinder neurological recovery, recent studies have highlighted the therapeutic potential of interventions like probiotics in targeting this axis. This review aims to focus on the efficacy of probiotic supplementation to support the gut microbiota-brain axis in trauma, neurosurgery, or pain based on the current clinical trials to assess the complex interplays among probiotics, the gut microbiota, and the central nervous system (CNS). This comprehensive literature review identified 10 relevant publications on probiotic interventions for various neurosurgical conditions across multiple countries. These studies demonstrated diverse outcomes, with significant improvements observed in gastrointestinal mobility, inflammatory responses, and infection rates, particularly in post-traumatic brain injury and spinal surgery. Probiotics also showed promise in mitigating antibiotic-associated diarrhea and modulating inflammatory cytokines. Despite the promising findings, the complex interplays among probiotics, the gut microbiota, and the central nervous system (CNS) call for cautious interpretation. Conflicting outcomes emphasize the need for better-designed trials to understand strain-specific and disease-specific effects accurately. In conclusion, probiotics offer a promising adjuvant therapy for neurosurgical patients, traumatic brain injuries, and post-spinal surgery. However, further well-designed randomized controlled trials are essential to elucidate the intricate relationship between microbiome-modulating interventions and the CNS via the gut microbiota-brain axis.
Keywords: neurologic injury, neurosurgery, probiotics, synbiotics, microbiota, brain injury
Published in DKUM: 21.11.2024; Views: 0; Downloads: 4
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3. Vaccines immunize people; legislation immunizes vaccine manufacturers. Legislation in the United States Regulating liability for the manufacture, distribution and administration of vaccinesThomas Allan Heller, 2021, original scientific article Abstract: Infectious diseases have caused widespread misery, and have wreaked havoc physically, mentally, economically, politically, and socially. Fortunately, in more recent years, scientists have developed vaccines. Vaccines are generally very safe, but cause side effects in a small percentage of cases. The United States Congress has passed two major pieces of legislation that provide sweeping tort immunity to vaccine manufacturers and others. In 1986 Congress passed the National Childhood Vaccine Injury Act (NCVIA) and in 2005 it passed the Public Readiness and Emergency Preparedness Act (PREP ACT). Both Acts were passed to encourage manufacturers to develop vaccines, particularly in times of public emergencies, in exchange for expansive liability protection. Both Acts established no-fault type compensation schemes to compensate those suffering injury or death from vaccines without having to resort to typical litigation. The author discusses both Acts in detail, in the context of the current Covid-19 crisis.
Keywords: vaccines, pandemics, Public Readiness and Emergency Preparedness Act, immunity from liability, National Childhood Vaccine Injury Act
Published in DKUM: 19.08.2024; Views: 68; Downloads: 8
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4. The role of oxidative stress in kidney injuryNejc Piko, Sebastjan Bevc, Radovan Hojs, Robert Ekart, 2023, review article Abstract: Acute kidney injury and chronic kidney disease are among the most common non-communicable diseases in the developed world, with increasing prevalence. Patients with acute kidney injury are at an increased risk of developing chronic kidney disease. One of kidney injury’s most common clinical sequelae is increased cardiovascular morbidity and mortality. In recent years, new insights into the pathophysiology of renal damage have been made. Oxidative stress is the imbalance favoring the increased generation of ROS and/or reduced body’s innate antioxidant defense mechanisms and is of pivotal importance, not only in the development and progression of kidney disease but also in understanding the enhanced cardiovascular risk in these patients. This article summarizes and emphasizes the role of oxidative stress in acute kidney injury, various forms of chronic kidney disease, and also in patients on renal replacement therapy (hemodialysis, peritoneal dialysis, and after kidney transplant). Additionally, the role of oxidative stress in the development of drug-related nephrotoxicity and also in the development after exposure to various environmental and occupational pollutants is presented.
Keywords: acute kidney injury, acute tubular necrosis, chronic kidney disease, oxidative stress, reactive oxygen species
Published in DKUM: 19.03.2024; Views: 210; Downloads: 33
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6. Low speed rear end automobile collisions and whiplash injury, the biomechanical approachAllan F. Tencer, 2019, original scientific article Abstract: The extent of injury in low speed rear end collisions is controversial. In many cases, the impact speed of the striking vehicle is low, neither car shows much if any post collision damage, and at the scene, the occupant of the struck vehicle appears uninjured. Yet many of these incidents progress to lawsuits with sometimes very significant damage and injury claims. In testimony, Plaintiff argues that the collision was significant while Defendant describes the collision as minor. A Biomechanical approach which addresses the forces in the collision and the resulting forces and kinematics of the occupant can help to resolve some of these issues. In the following, the process of a biomechanical analysis is described, using a specific example. A discussion of how courts have viewed this type of testimony is then presented.
Keywords: biomechanics, rear end collisions, cervical spine, whiplash, injury
Published in DKUM: 15.01.2021; Views: 656; Downloads: 128
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7. No fault compensation for medical injuriesVojko Flis, 2016, review article Abstract: For decades in both Europe and the United states , the issue of compensation for victims f medical injuries has led to lively debates. Many scholars have analyzed the adverse effects of the "tort system" (based on negligence standards and court proceedings) on the increasing costs of insurance premiums, on the patient-doctor relationship and the quality of care. These debates have led to changes in compensation in some countries. Compensation would be based not on negligence, but rather on a broader avoidable medical injury standard. Some nations have long operated administrative schemes based on no fault principle. No fault compensation model for victims of medical injuries might be characterized by the choices it makes regarding some key issues: (a) the definition of compensation criteria in particular the status given to fault; (b) the organization of the decision -making process. What type of body adjudicates medical claims? (c) Who finances the mechanism. What injuries are likely to be compensated for, to what extent and by whom? This article reviews the origins and operations of the no fault systems, the evolution of their compensation criteria, and how these criteria are actually applied.
Keywords: injury, compensation, liability, medical errors, negligence
Published in DKUM: 08.10.2018; Views: 1690; Downloads: 163
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8. Penetrantna poškodba torakalne aorte zaradi serijskega zloma reberVojko Flis, Jože Antonič, Zvonko Borovšak, Ivana Glumbić, Nina Kobilica, 2011, professional article Abstract: Namen: Poškodbe prsnega koša se pojavljajo pri 10-15 % vseh poškodb. Tope poškodbe prsnega koša, ki jih spremljajo serijski zlomi reber, so obremenjene z visoko obolevnostjo in umrljivostjo. Nestabilne zlome prsnega koša lahko zdravimo konservativno z ustrezno analgezijo, asistirano ventilacijo in čiščenjem bronhialnih izločkov. Toda takšno zdravljenje ne preprečuje poškodb, ki se lahko pojavijo zaradi zlomljenih reber, ki štrlijo v prsno votlino. Štrleče konice reber na levi strani prsnega koša lahko poškodujejo torakalno aorto. Take poškodbe so značilne za paravertebralne serijske zlome reber, za katere zaenkrat ne obstaja varen in splošno sprejet način osteosinteze. Poročilo o primeru: Prikazan je primer 68-letnega moškega z obojestranskim serijskim zlomom reber in nestabilnim prsnim košem. Poškodba je bila zdravljena z asistirano ventilacijo. Nekaj dni po poškodbi so zlomljena rebra v višini šestega in sedmega rebra levo predrla descendentno aorto in moški je umrl med oživljanjem in prevozom v operacijsko dvorano zaradi hemoragičnega šoka. Zaključek: Paravetebralni serijski zlomi reber na levi strani prsnega koša lahko povzročijo penetrantno poškodbo torakalne aorte. Za take poškodbe zaenkrat ne obstaja varen in splošno sprejet način osteosinteze.
Keywords: blunt thoracic trauma, rib fractures, penetrant injury to aorta
Published in DKUM: 10.07.2015; Views: 2674; Downloads: 90
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9. Primerjava napovedne vrednosti rezultatov lestvic RISC (Revised Injury Severity Classification) in TRISS (Trauma and Injury Severity Score) na slovenskem vzorcu hudo poškodovanihDrago Brilej, 2014, dissertation Abstract: IZHODIŠČA: Temeljni pogoj za zagotavljanje kakovosti zdravljenja je spremljanje rezultatov. Za objektivno oceno potrebujemo ustrezne podatke. Glavni namen registrov poškodovanih je pridobivanje podatkov o celotni verigi oskrbe od mesta nesreče do zaključka hospitalizacije. Zaradi razpršenosti poškodovancev po številnih bolnišnicah v Sloveniji je v Projektu razvoja mreže travmatološke dejavnosti predvidena uvedba nacionalnega registra poškodovancev. Za primerjavo rezultatov zdravljenja poškodovancev z mednarodnimi standardi se največ uporablja metodologija TRISS. Razvili so jo z multivariantno analizo skupine poškodovancev (MTOS), ki se pomembno razlikuje od slovenskega vzorca hudo poškodovanih. Zaradi te razlike se je porodil dvom o uporabnosti metodologije TRISS. Z vključitvijo slovenskih poškodovancev v nemški TR DGU pa smo prevzeli metodo RISC za primerjavo rezultatov zdravljenja z drugimi ustanovami. Nova metoda še ni bila ovrednotena na skupini, ki se razlikuje od poškodbenega vzorca v TR DGU. Namen naloge je preveriti uporabnost metode RISC na slovenskem vzorcu hudo poškodovanih in jo primerjati z metodo TRISS.
METODE: Od vstopa v TR DGU v letu 2006 smo v SB Celje prospektivno zajeli podatke o kohortni skupini 376 hudo poškodovanih in jih vnesli v TR DGU. Primerjali smo dejavnike tveganja med poškodovanci v SB Celje in TR DGU ter izračunali vrednosti TRISS in RISC za vsakega poškodovanca. S statistiko M smo primerjali porazdelitev izračunanih verjetnosti preživetja med SB Celje, MTOS in TR DGU. Za ugotavljanje ustreznosti točkovnih lestvic (TRISS, RISC in RISC II) smo uporabili statistične metode diskriminacije (aROC), natančnosti (razlika v preživetju) in kalibracije (statistika H-L).
REZULTATI: Povprečna starost poškodovancev je bila 47 let, 83 % je bilo moških, 95 % topih poškodb. Povprečna ISS vrednost je bila 26,4 (90 % ≥ 16). V bolnišnici je umrlo 17,5 % poškodovancev. Standardizirana umrljivost je pokazala za 1,9 % manjšo umrljivost, kot je predvidena s statističnimi modeli.
Ugotovili smo pomembno odstopanje v dejavnikih tveganja med poškodovanci v SB Celje in TR DGU, kar lahko razložimo z drugačnimi vključitvenimi merili. Potrdili smo, da je slovenski vzorec hudo poškodovanih drugačen, in da je treba preveriti učinkovitost metode RISC.
Primerjali smo preživetje med skupinami in ugotovili slabo ujemanje skupine poškodovancev v SB Celje z MTOS (M = 0,50) ter dobro ujemanje s TR DGU (M = 0,88). V dveh časovnih obdobjih (2006–07 in 2011–12) se porazdelitev v SB Celje ni pomembno spremenila (M = 0,90). Potrdili smo pomembno razliko med skupino MTOS in SB Celje, ki vpliva na uporabnost metode TRISS. Kljub razlikam v dejavnikih tveganja pa smo potrdili dobro ujemanje rezultatov med skupinama SB Celje in TR DGU, kar upravičuje uporabo metode RISC na slovenskem vzorcu hudo poškodovanih.
Najboljšo diskriminacijo sta pokazali lestvici RISC in RISCII (aROC 0,91 in 0,90). Najbolj natančna je bila lestvica RISC (razlika v umrljivosti 1,9 %), ki je prav tako imela najboljšo in skoraj popolno kalibracijo (H-L 0,53).
ZAKLJUČKI: Metoda RISC je pokazala boljšo diskriminacijo in kalibracijo, bila je bolj natančna kot metodologija TRISS za slovenski vzorec hudo poškodovanih. Primerjava podatkov v SB Celje v letih 2006-7 z leti 2011-2 je pokazala nekaj razlik. Predvsem je opazno izboljšanje na področju kazalnikov kakovosti oskrbe (krajši predbolnišnični čas, krajši čas na urgentnem oddelku). Toda te razlike niso vplivale na uporabnost metode RISC. Prestala je test sprememb v strukturi in obravnavi poškodovancev skozi čas. Metoda TRISS kljub novim koeficientom ni primerna za uporabo na slovenskem vzorcu hudo poškodovanih. Posodobljena RISC II je dobra metoda, a nič boljša od že uveljavljene RISC.
Keywords: hudo poškodovani, vrednotenje, Trauma and Injury Severity Score (TRISS), Revised Injury Severity Classification (RISC), register
Published in DKUM: 26.01.2015; Views: 2143; Downloads: 302
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