Uvod: Procjena volumskog statusa i venske kongestije u bolesnika s uznapredovalim srčanim popuštanjem ostaje klinički izazov. VExUS protokol (engl. Venous Excess Ultrasound Score) temelji se na ultrazvučnoj procjeni venskog sustava i omogućava neinvazivnu, brzu i lako ponovljivu procjenu kongestije. Prikaz slučaja: Prikazujemo 92-godišnju bolesnicu s brojnim pridruženim bolestima i terminalnim srčanim popuštanjem, zaprimljenu zbog dispneje, hipoksije i znakova kongestije. Ultrazvučni pregled trbuha izveden je konveksnom sondom (2–5 MHz) u skladu s važećim tehničkim preporukama, u supiniranom položaju s desne lateralne strane. Nalaz je pokazao redukciju bubrežnog parenhima, povišeni rezistivni indeks (RI 0,78) te izrazitu dilataciju donje šuplje vene (4,5 cm) i hepatalnih vena s dominacijom D vala (VExUS gradus 2). Početno ciljano vođena terapija prema nalazu VExUS-a dovela je do privremene stabilizacije. Bolesnica je otpuštena nakon privremene stabilizacije temeljem ciljano vođene terapije, no dva puta se vratila u bolnicu, a pri trećem dolasku preminula unatoč poduzetim mjerama liječenja.. Zaključak: Prikaz potvrđuje kliničku vrijednost VExUS-a u hitnoj medicinskoj službi te podupire sustavnu primjenu u praćenju bolesnika visokog rizika od srčanog popuštanja.
Cilj je ovog rada pružiti spoznaje za zbrinjavanje bolesnika s kroničnom bubrežnom bolesti u slučaju najčešćih prirodnih katastrofa vodeći se najnovijim dokazima i preporukama. MEDLINE i Web of Science baze podataka su pretražene koristeći kombinacije ključnih riječi “kronična bubrežna bolest”, “katastrofe” i “zbrinjavanje katastrofa”. Relevantni istraživački radovi te trenutne smjernice internacionalnih društava su analizirani kako bi se ekstrapolirale preporuke i prilagodbe prakse optimalne za pravilno postupanje i planiranje u slučaju katastrofičnih situacija. U ovome radu predočene su mogućnosti intervencija u smislu kontrole nastale štete i jasnih uputa zbrinjavanja u katastrofičnoj situaciji neovisno o kojoj se katastrofi etiološki radi s ciljem osiguranja kvalitete života bolesnika uz optimizaciju zdravstvenog sustava.
Background: A proper diet plays a major role in preserving thequality of life and health for each individual. For healthcareworkers, shift work can result in irregular and poor-qualitydietary intake, which can lead to the development of healthproblems and chronic diseases.Aim: This study aimed to analyse dietary habits amonghealthcare workers based on their work schedules (morningshifts vs. rotating/shift work) using validated dietaryassessment tools.Methods: A cross-sectional study was conducted fromDecember 2023 to March 2024 in various departments ofthe Merkur Clinical Hospital. A total of 147 participants(physicians, nurses, and healthcare assistants) were surveyedusing two validated instruments: the Mediterranean DietAdherence Screener (MEDAS) and the Mediterranean DietServing Score (MDSS). Descriptive statistics and t-tests wereused to compare dietary patterns between groups, withp-values <0.05 considered statistically signifi cant.Results: A statistically signifi cant difference was observedin dessert consumption, with morning shift workersconsuming sweets more frequently (M = 3.67, SD = 2.39) thanshift workers (M = 2.70, SD = 2.21; p < 0.05). In contrast, shiftworkers consumed signifi cantly more wine than morningshift workers (M = 1.04, SD = 1.71 vs. M = 0.41, SD = 0.75;p < 0.05).Conclusion: The fi ndings suggest that work schedules areassociated with distinct dietary patterns among healthcareworkers. Morning shift workers show a preference forsweets, while shift workers consume more alcohol. Theseresults highlight the need for targeted workplace dietaryinterventions, including improved access to healthy mealsand strategies to promote balanced eating across all shifts.
Whole blood was the first human blood product to be transfused in modern medicine, seeing widespread use during the final months of World War I. With the advent of blood component therapy and the concept of using intravenous crystalloid fluids for initial resuscitation of hemorrhagic shock in trauma, whole blood transfusion had been forgotten as a therapeutic possibility during the larger part of the 20th century. Owing to the successful military use of whole blood in the early 1990s, extending to the early 2000s, whole blood has resurfaced as a lucrative therapeutic option for civilian trauma in the early 2010s, with approximately 25 % of level I trauma centers in the United States using whole blood transfusions in 2020. However, a large part of the developed world is still hesitant on the benefits of using whole blood both in prehospital and in-hospital trauma resuscitations, owing to the relative scarcity of high-quality evidence (especially randomized controlled trials) on its effectiveness and safety when compared to the current standard of care - blood component therapy. With recently published prospective studies demonstrating either noninferiority or marginal superiority of whole blood transfusion to blood component transfusion, interest in the use of whole blood has once again increased. This narrative review aims to present the history, technical aspect and current evidence for the use of whole blood in both the military and civilian trauma settings in a concise, succinct manner and inform the reader on the contexts and situations in which whole blood transfusion might provide the greatest benefit, both logistics and cost-wise and mortality-wise.
