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EN
The aim of this study was to determine the types nosocomial infections (NIs) and the risk factors for NIs in the central intensive care unit (ICU) of Trakya University Hospital. The patients admitted to the ICU were observed prospectively by the unit-directed active surveillance method based on patient and the laboratory over a 9-month-period. The samples of urine, blood, sputum or tracheal aspirate were taken from the patients on the first and the third days of their hospitalization in ICU; the patients were cultured routinely. Other samples were taken and cultured if there was suspicion of an infection. Infections were considered as ICU-associated if they developed after 48 hours of hospitalization in the unit and 5 days after discharge from the unit if the patients had been sent to a different ward in the hospital. The rate of NIs in 135 patients assigned was found to be 68%. The most common infection sites were lower respiratory tract, urinary tract, bloodstream, catheter site and surgical wound. Hospitalization in ICU for more than 6 days and colonization was found to be the main risk factor for NIs. Prolonged mechanical ventilation and tracheostomy, as well as frequently changed nasogastric catheterization, were found to be risk factors for lower respiratory tract infections. For bloodstream infections, both prolonged insertion of and frequent change of arterial catheters, and for urinary tract infections, female gender, period and repeating of urinary catheterization were risk factors. A high prevalence rate of nosocomial infections was found in this study. Invasive device use and duration of use continue to greatly influence the development of nosocomial infection in ICU. Important factors to prevent nosocomial infections are to avoid long hospitalization and unnecessary device application. Control and prevention strategies based on continuing education of healthcare workers will decrease the nosocomial infections in the intensive care unit.
EN
The aim of the present case-control study was to assess the risk factors for Basal cell carcinoma (BCC) in the Montenegrin population. The study group was comprised of 100 consecutive patients with a diagnosis of BCC, while the control group consisted of patients who did not present skin cancer and who were individually matched to the cases by sex and age. The increased risk for BCC was associated with: the presence of nevi (odds ratio [OR] = 3.77; 95% confidence interval [CI] = 1.12–12.73), type of skin concerning to burn rather than to tan after repeated sun exposure in childhood or adolescence (OR = 3.14; 95% CI = 1.59–6.18), the skin reaction to burn after two or more hours of sunlight during childhood or adolescence (OR = 4.53; 95% CI = 2.37–8.63), the number of severe and painful sunburns during their lifetime(OR = 3.52; 95% CI = 1.68–7.38), outdoor work during the summer-time (OR = 2.73; 95% CI = 1.00–7.45), occupational exposure to chemicals (OR = 17.89; 95% CI = 2.82–113.52), history of eczema (OR = 4.17; 95% CI = 1.53–11.39), and history of previous BCC (OR = 3.86; 95% CI = 1.40–10.65). Our study confirms the role of environmental and constitutional factors in development of BCC.
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Risk factors for osteoporosis in healthy males

100%
EN
We investigated the correlation of bone mineral density (BMD) with risk factors and laboratory parameters (e.g., markers of bone turnover, biochemical indicators, and hormonal factors) in males without secondary osteoporosis. A total of 105 males were divided into two groups: Group 1 (n: 52) <60 years, and Group 2 (n:53) ≥ 60 years. The subjects were evaluated for risk factors (European Vertebral Osteoporosis Study (EVOS) and BMD) and for biochemical (i.e., blood calcium, blood phosphorus, urinary calcium/phosphorus, creatinine clearance, osteocalcin, and deoxypyridinoline) and hormonal markers (follicle-stimulating hormone [FSH], luteinizing hormone [LH], free testosterone [fT], and parathyroid [PTH]) of bone mineral metabolism. In Group 1, no significant relationship was observed between risk factors for both lumbar and femoral neck BMDs and risk factors and laboratory parameters (p>0.05). On the other hand, we observed in Group 2 a significant positive correlation between lumbar BMD and BMI, BMI at 25 years of age, and fT; in the same group, a negative correlation between lumbar BMD and deoxypyridinoline (p<0.05) was seen. We saw a significant positive correlation between femoral neck BMD and BMI, BMI at 25 years of age, and daily activities of life in Group 2. In addition, we saw a negative correlation between femoral neck BMD and height difference, fT, LH, and deoxypyridinoline in Group 2 (p<0.05). Risk factors for male osteoporosis were multifactorial: demographic and clinical data (difference of height, BMI, physical activity) together with biochemical and hormonal data (deoxypyridinoline, fT, LH) were significant, and most of the risk factors analyzed were related to bone loss in the proximal femur.
EN
Lung cancer is rated with the highest incidence and mortality every year compared with other forms of cancer, therefore early detection and diagnosis is essential. Artificial Neural Networks (ANNs) are “artificial intelligence” software which have been used to assess a few prognostic situations. In this study, a database containing 193 patients from Diagnostic and Monitoring of Tuberculosis and Illness of Lungs Ward in Kuyavia and Pomerania Centre of the Pulmonology (Bydgoszcz, Poland) was analysed using ANNs. Each patient was described using 48 factors (i.e. age, sex, data of patient history, results from medical examinations etc.) and, as an output value, the expected presence of lung cancer was established. All 48 features were retrospectively collected and the database was divided into a training set (n=97), testing set (n=48) and a validating set (n=48). The best prediction score of the ANN model (MLP 48-9-2) was above 0.99 of the area under a receiver operator characteristic (ROC) curve. The ANNs were able to correctly classify 47 out of 48 test cases. These data suggest that Artificial Neural Networks can be used in prognosis of lung cancer and could help the physician in diagnosis of patients with the suspicion of lung cancer.
EN
There is no consensus regarding the time of antiepileptic drug withdrawal and the relevant risk factors for seizure relapse. In this study, we aimed to determine the seizure relapse rates and the associated risk factors for seizure relapse in childhood epilepsy. Two-hundred sixty-six epileptic patients who discontinued the antiepileptic drug therapy after a seizure-free period of at least two years, were enrolled into the study. The data of the patients regarding sex, febrile convulsion history, family history, age at onset, type of epilepsy, total number of seizures and antiepileptic drugs, seizures during treatment, mental status, first and last electroencephalography, brain imaging findings, etiological factors and seizure relapse in the first two years after antiepileptic drug withdrawal were obtained from the patients’ files. Univariate logistic regression analysis was performed for each variable. The variables which were found to be statistically significant in univariate analysis, were included in multivariate logistic regression analysis. The overall seizure relapse rate after antiepileptic drug withdrawal was 19.2%. There were no significant differences for seizure relapse rate after antiepileptic drug withdrawal between patient groups with respect to sex, family history, type of epilepsy, febrile convulsion history, seizures before treatment, first electroencephalography findings, brain imaging findings and etiology. However, there were statistically significant differences for seizure relapse rate among patient groups concerning age at onset of epilepsy, new seizure during treatment, the total number of antiepileptic drugs, mental status, and last electroencephalography findings. We imply that the clinical status of the patients should be considered before the cessation of drug therapy rather than the etiological factors or laboratory findings.
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EN
The aim of this study was to investigate the prevalence and predictors of alcohol consumption among adolescents in one town in Central Serbia. A questionnaire was used to obtain data from 191 Serbian students aged 18 years regarding personal experience with alcohol consumption and cigarette smoking, along with sociodemographics data. Alcohol consumption was reported by 97.4% subjects, with 34.9% having the first experience with alcohol at the age of 14 years or less. Binge drinking (the intake of five or more drinks at one sitting) was reported by 37.8% subjects. Significantly higher consumption of beer (p<0.0001) and spirits (p=0.03) was observed in boys. The most common reason for both initiation and continuation of drinking, regardless of gender, were celebrations (p≥0.12). Smokers were more likely than nonsmokers to consume all alcoholic beverages more frequently (p≤0.04) and in larger quantities (p≤0.004). More frequent or more extensive alcohol consumption, or both, was associated in boys with frequent going out and socializing (p≤0.01), close peer relationship (p=0.04), alcohol abuse within the immediate environment (p≤0.04), better financial status of family (p=0.04), and parental criticism (p≤0.02); in girls, it was associated with parental disapproval (p≤0.02), alcohol abuse within the immediate environment (p≤0.04), and general discontentedness (p=0.049). Regardless of gender, positive alcohol outcome expectancies increased alcohol consumption (p≤0.048), and negative expectancies decreased intake (p≤0.047).
EN
Diabetes mellitus with its limb and life-threatening complications such as diabetic foot infection and amputation are increasing at epidemic rates all over the world. The objective of this study was to determine the rate of lower extremity amputation, the risk factors and the bacteriologic profile for diabetic foot lesions. The records of all 84 patients with diabetic foot infections of a large general hospital over a 4-year period were retrospectively included. The most commonly isolated pathogens were Staphylococcus aureus (39%), Pseudomonas aeruginosa (14%), Proteus mirabilis (14%), Escherichia coli (14%), Group B streptococci (12%), and Klebsiella pneumonia (8%). The variables, independently associated with higher foot infections, were inadequate diabetic regulation (93%), peripheral neuropathy (88.1%), peripheral vascular disease (73.8%), smoking (56%), past history of ulcer (28.5%), penetrating injury (20.3%), inadequate foot wear (15%) and Charcot osteoartropathy (10.7%). The general amputation rate was 38.1%. Diabetic foot ulcers and its complication rates including infection, gangrene and lower extremity amputation in Turkey are still high. Preventive care of the foot in patients with diabetes mellitus is extremly important. Therefore early diagnosing of risk factors for diabetic foot infections in the primary care setting and their adequate therapy under multidisciplinary approach should not be neglected.
Open Medicine
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2008
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vol. 3
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issue 3
308-314
EN
The etiology of coronary artery disease (CAD) is multifunctional. There is increasing evidence that dental infections could play a role in the initiation and development of CAD. In a case control double blind study, one hundred male and female (mean age 51 ± 9.4) angiographically documented CAD, compared with one hundred male and female patients (mean age 50.6 ± 9) with angiographically negative coronary artery. All the patients (cases and control) underwent dental examination for the presence and severity of periodontitis by a dentist who was oblivious the result of the angiography performed. The association between periodontal disease status and CAD was significant (P=0.011); periodontitis was apparently more frequent in CAD positive patients than in control (86% versus 61%). Adjustment of coronary risk factors (smoking, DM, hypertension and hyperlipidemia) in both cases and control groups suggests that the association between periodontitis and CAD in our study was independent of coronary risk factors. There is increasing evidence that dental infection, especially aerobic organisms which have capability of aggregation of platelets, is the most important cause. Dental infection would be an independent risk factor for CAD.
EN
The metabolic syndrome presents a serious challenge to health professionals. The aim of the present study is to analyze the impact of a brief counselling on cardiovascular risk factors among 40-year-old men. Forty-six males living in north-eastern Helsinki voluntarily completed the follow-up study between 2001 and 2004, and were assessed for clinical risk factors. The mean differences were determined by a paired t-test, and the interaction between groups and time by the F-test with repeated measures ANOVA. After baseline assessment and in 2002, males received a 45 minute nurse-delivered counselling session with self-administered protocol. Cardiovascular risk factors improved significantly (p<0.05) from baseline within months. However, the final measurements obtained after three years showed that almost all risk factors, except the low and high density lipoprotein, tended to revert back to baseline. The profiles were similar in all predictor groups. Brief counselling had an impact on risk factors measured in 2002, but only a partial effect on them in 2004. Conclusive results lead to the idea thatmore collaboration is needed between private health care agencies and official primary health care for ensuring the continuity of improved health habits among middle-aged males.
EN
Cardiovascular complications, including stroke, may be attributed the highest rate of morbidity and mortality in patients with chronic kidney disease (CKD). The aim of our study was to evaluate the prevalence of CKD in patients with symptomatic ischaemic cerebrovascular disease and to establish of whether CKD may define a particular risk pattern of cerebral vessels modifications in this category of patients. The prevalence of CKD was evaluated in 590 consecutive patients with symptomatic ischaemic cerebrovascular disease admitted to a department of neurology. The types of stroke, the vascular territories, the vascular modifications and the haemodynamic changes (resistance index- RI) found by neurosonology (extracranial and transcranial Doppler ultrasound) were analysed in relation to classic and non-classic cerebrovascular risk factors, as well as to stages of CKD (defined by estimated glomerular filtration rate-eGFR-MDRD4 formula-K/DOQI 2002). The prevalence of CKD in the studied patients was 70.84%. Atherosclerosis in a diffuse pattern was detected in 79.7% of CKD patients, while carotid artery stenoses were found in 10% of cases, occlusions- 5.3%, stenoses + occlusions-1.2%, and multiple stenoses- 3.8% of cases. The RI evaluated in the internal carotid arteries correlated with fibrinogen(P<0.0001) and GFR(P<0.0001), while IR in the middle cerebral arteries correlated with fibrinogen(P<0.05), C-reactive protein(P<0.0001), and GFR(P<0.0001). There is a strong relation between symptomatic cerebrovascular disease and CKD, a fact demonstrated by the increased prevalence of CKD in these patients and by the severity of the cerebral vessels lesions.
EN
The results of conducted research studies suggest that heredity and early fetal and neonatal development play a causal role in autism. The objective was to determine a relationship between pre-, peri-, and neonatal factors and autism. The relationship between genders and individual risk factors for autism was also examined. A case-control study was conducted among 288 children (96 cases with childhood or atypical autism and 192 controls individually matched to cases by the year of birth, sex, and general practitioners). Data on autism diagnosis and other medical conditions were acquired from physicians. All other information on potential autism risk factors were collected from mothers. Autism risk was significantly higher when mothers were taking medications (OR=2.72, 95%CI: 1.47-5.04) and smoked during pregnancy (OR=3.32, 95%CI: 1.12-9.82). It was also significantly associated with neonatal dyspnea (OR=3.20, 95%CI: 1.29-8.01) and congenital anomalies (OR=7.17, 95%CI: 2.23-23.1). In gender analysis only congenital anomalies were significantly associated with autism for girls but all of mentioned factors stayed independent risk factors for boys.
EN
The study is a retrospective analysis of data obtained from a cardiovascular disease prevention program financed by the National Health Fund (Poland). The aim of the study was to evaluate the population to demonstrate the prevalence of favourable and unfavourable lipid parameters and blood pressure values depending on age and BMI. A total of 2,616 subjects were included in the study (811 men and 1805 women aged between 35 and 55 years of age) who perceived themselves as completely healthy individuals and in whom no cardiovascular disease or diabetes mellitus had been diagnosed. We evaluated blood pressure values, body weight, height, BMI, fasting glucose, total cholesterol, triglycerides, HDL and LDL in the serum of venous blood. The above-mentioned parameters were compared in women and men depending on BMI and age. It was demonstrated that the epidemiological situation of women in the analysed age group, regardless of the studied parameter and method of its evaluation, is much more favourable than that of men. We have demonstrated that evaluation of the analysed lipid parameters and blood pressure should be performed with consideration to gender and age. Otherwise conclusions may be obtained which are not satisfied by 75-95% of the population in a given age group. Obesity was highlighted as a factor triggering further lipid disturbances and blood pressure increase.
EN
The aim of this study was to assess the associations of the body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with ischemic heart disease (IHD) and risk factors of IHD in the Lithuanian population aged 25 to 70 years. The cross-sectional health survey was carried out in Kaunas, which is the second largest city in Lithuania, and in five regions randomly selected from the northern, southern, eastern, western and central parts of Lithuania. Data from 2048 subjects (936 men and 1112 women) were analyzed. In both sexes, the odds ratios for reduced high density lipoprotein cholesterol, elevated triglycerides, high fasting blood glucose, and hypertension rose with an increasing quartile of BMI, WC, and WHtR. The likelihood of having IHD was statistically significantly higher in the fourth quartile of these anthropometric measures when compared to the first one. Comparison of the logistic regression models revealed that the models with WHtR best fit the prediction of IHD risk. Compared with BMI and WC, WHtR showed a stronger association with IHD and its risk factors in the Lithuanian adult population.
EN
Background: Up to date, the assessment of adherence to the treatment of children with asthma in Kazakhstan has not been carried out yet. Objective: The study aimed to evaluate the level of therapeutic adherence of paediatric patients with asthma in urban and rural areas of Kazakhstan. In addition, the validity and reliability of a structured scale for assessing adherence in patients with asthma was also scrutinized. Methods: A prospective study of verified cases of bronchial asthma of 518 children in the dispensary control in the Children’s City Clinical Hospital N2 (Almaty, Kazakhstan) was conducted in the period from 2018 to 2020. Children with asthma were sub-divided into 2 groups: urban and rural residents. The demographic and clinical characteristics, external and social factors of the patients were analysed. Patient adherence to treatment was assessed using the Lebanese Medication Adherence Scale-14(LMAS-14). The reliability was tested using the measure of internal consistency (Cronbach’s alpha). Data were collected after the discharge from the hospital (T1) and after 6 months (T2). Results: Urban and rural patients made up 81.3% vs. 18.7% respectively. Children aged 5-12 years accounted for 70.6%. Male gender was predominant in all groups (p=0.73). Better financial situation, education were noted by 90.5% and 95.5% of urban parents (p=0.001). The influence of external factors (dampness, coal heating and possession of pets) was higher in rural areas (p=0.001).The results of study based on the LMAS-14 questionnaire (T1 period) showed no significant differences. However, in the T2 period, the adherence of urban children was higher than rural ones (p=0.001). The Cronbach’s α was 0.606 for the total score. According to the results of a survey after 18 months, a significant relationship was found between the levels of adherence and the frequency of asthma attacks (p=0.001). Conclusion: In 2018-2020, a low therapeutic adherence of children with asthma, especially in a rural area, was detected in the territory of the Republic of Kazakhstan. Our findings indicate the necessity to develop effective measures to regulate and increase adherence to treatment of patients, especially those living in rural areas.
EN
The aim of this study was to determine the prevalence of chronic disease and the risk factors for herpes zoster infection. In this case-control study medical records were collected from 55 patients who presented with herpes zoster and 54 patients in a control group who presented with gastroenterocolitis. Both groups were treated at the Clinic for Infectious Diseases, University Clinical Hospital Mostar from January, 2005 to December, 2010. When we compared the herpes zoster group with the control group, we did not demonstrate any significant difference in the overall prevalence of chronic diseases. However, the prevalence of diabetes and cancer was statistically higher when compared to the control group. A statistically significant difference in the number of cigarette smokers was not observed, whereas the number who consumed alcohol in the herpes zoster group was significantly higher compared to the control group. The correlation between alcohol and herpes zoster could help in solving the reactivation mechanism of VZV.
17
Content available remote

Predictors of diabetic nephropathy

75%
Open Medicine
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2013
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vol. 8
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issue 3
287-296
EN
Diabetic nephropathy (DN) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Alarming recent data described diabetes as an unprecedented worldwide epidemic, with a prevalence of ∼6.4% of the world population in 2010, while the prevalence of CKD among diabetics was approximately 40%. With a clinical field hungry for novel markers predicting DN, several clinical and laboratory markers were identified lately with the promise of reliable DN prediction. Among those are age, gender, hypertension, smoking, sex hormones and anemia. In addition, eccentric left ventricular geometric patterns, detected by echocardiography, and renal hypertrophy, revealed by ultrasonography, are promising new markers predicting DN development. Serum and urinary markers are still invaluable elements, including serum uric acid, microalbuminuria, macroalbuminuria, urinary liver-type fatty acid-binding protein (u-LFABP), and urinary nephrin. Moreover, studies have illustrated a tight relationship between obstructive sleep apnea and the development of DN. The purpose of this review is to present the latest advances in identifying promising predictors to DN, which will help guide the future research questions in this field. Aiming at limiting this paramount threat, further efforts are necessary to identify and control independent modifiable risk factors, while developing an integrative algorithm for utilization in DN future screening programs.
EN
Hypertension, diabetes, hyperlipidaemia, obesity and smoking are known to be the most important modifiable risk factors for cardiovascular disease (CVD). Because the elderly population has been increasing globally, CVD may become a more important public health problem in the future. This report examines the prevalence of cardiovascular risk factors in the elderly in Ankara, Turkey. This was a cross-sectional survey and included a total of 2720 individuals living in the Ankara district. Trained research staff administered a standard questionnaire in the participants’ homes and worksites. The questionnaire collected information on clinical and demographic characteristics and a self-reported medical history, including past history of hypertension, diabetes, hyperlipidemia, coronary artery disease, coronary artery by-pass graft operation, and cerebrovascular accident. The mean age of the study participants was 69.5 ± 7.2 years. The study identified 1298 women (78.1%) and 753 men (71.2%) with hypertension, and the overall prevalence of hypertension was 75.4%. A total of 739 (27.2%) people had diabetes mellitus, and, of these people, 603 (81.6%) were hypertensive. A total of 1361 people had hyperlipidemia, and 1103 of these patients were also hypertensive. The overall prevalence of obesity was 27.2%. A total of 553 (20.3%) people were smokers. Our findings indicate that cardiovascular risk factors are very common in the elderly. To maximize risk reduction, physicians must take aggressive measures to decrease cardiovascular risk factors.
Open Medicine
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2008
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vol. 3
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issue 3
358-360
EN
Blood stream infections due to Candida species are becoming increasingly important causes of morbidity and mortality in hospitalized patients. Risk factors that predispose patients to developing invasive Candida infections have been documented as, iatrogenic and/or nosocomial conditions and immunosuppression. In the present report, we want to emphasize the risk factors that predispose individuals to the development of candidemia, particularly those that are relevant to our patient. We describe a female patient with diabetes mellitus who had been receiving glucocorticoids for 20 years as replacement therapy for hypopituitarism resulting from hypophysis adenoma surgery. The patient received antibiotic therapy for recurrent wound infections and was hospitalized for a long time, including a period in the intensive care unit and instrumented. The patient eventually succumbed to fungemia caused by a fluconazole-resistant strain of C. albicans strain.
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