Search

Introduction This study tried to investigate the impact of oXiris filter on both clinical and laboratory parameters in critically ill COVID-19 ICU patients receiving extracorporeal blood purification and the clinical setting for the initiation of therapy. Methods A consecutive sample of 15 ICU patients with COVID-19 was treated with oXiris membrane for blood purification or for support of renal function due to acute kidney injury. We have included 19 non treated ICU COVID-19 patients as a control group. Two chest X-rays were analyzed for determining the chest x-ray severity score. Results We have found a significant decrease of SOFA score, respiratory status improved and the chest X-ray severity score was significantly decreased after 72h of treatment. Il-6 significantly decreased after 72h of treatment while other inflammatory markers did not. Respiratory status in the control group worsened as well as increase in SOFA score and chest X-ray severity score. Survived patients have shorter time from the onset of symptoms before starting with extracorporeal blood purification treatment and shorter time on vasoactive therapy and invasive respiratory support than deceased patients. Conclusion Critically-ill patients with COVID-19 treated with extracorporeal blood purification survived significantly longer than other ICU COVID-19 patients. Treatment with oXiris membrane provides significant reduction of Il-6, leads to improvement in respiratory status, chest X-ray severity score, and reduction of SOFA score severity. Our results can suggest that ICU COVID-19 patients in an early course of a disease could be potentially a target group for earlier initiation of extracorporeal blood purification. This article is protected by copyright. All rights reserved.

RVD increases the risk of hospitalisations, while RVFWS may serve as an echocardiographic indicator in hemodynamically significant left side valvular disease and add value in risk stratification in multiple valve disease in case of aorticomitrak stenotic disease.

Although recent studies described platelet reactivity (PR) changes in days after transcatheter aortic valve implantation (TAVI), precise time course and duration of these changes have not been fully investigated. The aim of this study was to investigate PR pattern during and after TAVI in multiple time points. Study included 40 consecutive patients undergoing TAVI. All patients underwent the procedure on dual antiplatelet therapy. PR was measured in 7 time points: before induction of anesthesia (T1), after heparin administration (T2), 10 minutes after initial valve implantation (T3), at the end of procedure (T4), and on 3rd, 6th, and 30th postoperative day (T5-T7). PR was measured using impedance aggregometer using 3 different platelet aggregation agonists (arachidonic acid in ASPItest, adenosine diphosphate in ADPtest and thrombin receptor activating peptide 6 in TRAPtest). All patients underwent successful TAVI procedure. Mean PR on T1 was 22.9 ± 23.0 U for ASPItest, 40.5 ± 23.7 U for ADPtest and 91.7 ± 32.5 U for TRAPtest. There was no significant difference in PR on T2. On T3, significant reduction of PR in all 3 tests was observed [ASPI 10.4 ± 11.6 U (P = 0.001), ADP 24.2 ± 14.1 U (P < 0.001) and TRAP 69.3 ± 26.6 U (P < 0.001)]. PR nadir for all tests was reached on T5, with subsequent PR incline. PR values in all tests returned to baseline levels on T7. Our results show that successful TAVI procedure induces transient decrease in PR regardless of the platelet activation pathway.

Introduction Although recent studies described changes in platelet reactivity (PR) in days following transcatheter aortic valve implantation (TAVI), precise time course and duration of these changes have not been fully investigated. Purpose To investigate PR changes during and after TAVI. Methods Study included 42 consecutive patients with severe and symptomatic aortic stenosis undergoing TAVI procedure in our institution. Patients' clinical characteristics were collected from medical records. All patients who did not have chronic dual antiplatelet therapy received loading dose of aspirin and clopidogrel (300 mg) one day before the procedure followed by their standard maintenance doses for next three months. PR was measured in six time points: just before induction of anaesthesia (T1), after heparin administration (T2), at the end of procedure (T3), and on 3rd, 6th and 30th postoperative day (T4–6). PR was measured using impedance aggregometer (Multiplate® analyzer, Roche, Munich, Germany) in response to three platelet aggregation agonists: arachidonic acid (ASPItest), ADP (ADPtest) and thrombin receptor activating peptide-6 (TRAPtest). Results Mean patient age was 82.1 years with majority of patients being male 57.1% (N=24). Mean valve area and mean transvalvular gradient prior to procedure were 0.71±0.21 cm2 and 49.1±18.7 mmHg, respectively. All patients underwent successful TAVI procedure using either self-expandable (N=25, 59.5%) or balloon-expandable valve. Two patients (4.7%) underwent transapical TAVI, while transfemoral approach was used in all other patients. Mean postimplantation gradient was 10.2±7.1 mmHg. Mean PR on T1 was 24.3±23.1 U for ASPItest, 41.6±26.5 U for ADPtest and 90.1±33.3 U for TRAPtest. There was no significant difference in PR on T2. However, on T3, ignificant reduction of PR in all 3 tests was observed (ASPI 9.4±10.1 U (p=0.001), ADP 23.1±15.0 U (p Conclusions Our results show that successful TAVI procedure induces transient decrease in PR regardless of the platelet activation pathway. These findings add new knowledge in understanding complexed relations in intravascular milieu following TAVI. Further research on a larger number of patients is needed to confirm and asses clinical significance of these results. Acknowledgement/Funding Croatian Science Foundation

Introduction: More than mild paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) represents one of the negative predictive factor for survival and quality of life after TAVI1. However, quantification and definition of more than mild PVR remains to be unified. Most commonly used 3 stage grading scheme is often insufficient2. Aim of this research was to assess differences in incidence of more than mild PVR during and after TAVI comparing 3 and 5 grades staging schemes. Patients and Methods: Study included 40 patients that underwent TAVI between July 2016 and January 2019 in general anesthesia with transesophageal echocardiography (TEE) during procedure. TEE exams had to be sufficiently recorded to quantify PVR with both grading schemes. Parameters used for PVR quantification and differences between models are presented in Table 1. Results: After initial valve implantation 10 (25%) patients had more than mild PVR when quantified using 3 grade model compared to 19 (47.5%) using 5 grade model (p

Introduction: Age and gender may influence the incidence of aortic regurgitation (AR) and its severity. Significant aortic regurgitation (sAR) is often treated surgically especially when symptomatic or when systolic function declines.1 The aim of this study was to evaluate the outcomes in patients with sAR according to treatment strategy, age and gender differences in our study population. Patients and Methods: In this retrospective descriptive single-centre study an overall of 107 patients (22 female, 85 male) with significant AR in the last 5 years were analyzed. Patients were treated according to valid recommendations, surgically (SUR) or conservatively (CON), except for 5 patients who refused surgery. Baseline and follow up (FU) data (AR severity, left ventricle ejection fraction (LVEF), ascending aorta diameter (AA), treatment, comorbidities and major adverse cardiovascular events (MACE) during FU), from documented medical history and digital imaging data were collected and analysed. Additional sub-analysis was performed according to sex and age differences (above vs. below the age of 50). For statistical analysis a Chi-Square test was used. Results: In the overall study population, during an average FU of 3.8 years, 16 patients (15%) developed MACE with no statistically significant difference between gender (p=0.846). Forty-six (43%) patients were surgically treated (87% male, 13% female) and 61 (54%) conservatively. LVEF did not worsen in FU period (54.1%, vs. 53.8%). In SUR, median age was 54 years, severe AR was present in 93%, incidence of MACE was 21.7%, 80.4% patients were symptomatic and 14.5% had dilatation of AA more than 50 mm. In CON, MACE was present in 9.8% during FU (p=0.87), median age was 64 years. Moderate AR (48% vs 6.5%) and AA from 40-49 mm (80 vs 35%) was present more frequently as well as arterial hypertension (82 vs 70%) and chronic renal disease (23.2 vs 16.6%). The incidence of MACE was not found to be agerelated (p=0.426). Conclusion: In patients with sAR treated by either surgery or medication therapy only, during 3.8 years of FU, LVEF remained unchanged, while incidence of MACE was not found to be related to treatment strategy nor gender. In surgically treated patients, as expected, AR was more severe and AA was more dilated, while neither age nor gender had an impact on the incidence of MACE.

The aims of this study were to evaluate diagnostic value of endoscopic ultrasound strain ratio elastography in patients with focal pancreatic masses and to determine the cutoff value between the pancreatic malignancies and inflammatory pancreatic masses using reference areas different than those used by other investigators. In a prospective single-center study, strain ratio was measured in patients with pancreatic masses. After the diagnosis was established, statistical analysis was used to compare the group with pancreatic malignancies to the one with inflammatory masses. Strain ratio cutoff of 7.59 provided 100% sensitivity, 95% specificity, and 97% overall accuracy for differentiation of patients with pancreatic malignancies from those with inflammatory masses. Our data show high sensitivity and specificity for the calculated strain ratio. Adjacent normal pancreatic tissue is adequate as a reference area based on the inclusion criteria. Diverse cutoff values and standardization of methods in the studies published so far require further investigations, before the implementation of the method in a routine clinical practice becomes possible.

Almost 70% of chronic hepatitis C (CHC) patients will have concomitant hepatic steatosis (HS) usually determined with invasive method. HS serve as negative predictive factor for lower sustained viral response (SVR) in CHC patients treated with standard of care (SOC) (PEG-IFN and Rib). Retrospective analysis of biochemical, virological and histological data in CHC patients treated with PEG-IFN and Ribavarin. Statistical analysis was carried out by Biometriha Healthcare Research. Level of significance was set to 95% (p0.05). 72 patients (43 M; 29 F; median age 41 y) with CHC (60 G1; 12 G3) with no concomitant metabolic syndrome were analyzed. HS ranged from 5 to 30% (median 15%). Overall accuracy of prediction of SVR based on the levels of HS was AUC=0.71 (95% CI=0.58-0.84; p=0.005). When HS was split regarding cut-off value of 5% significant difference was found between responders and non-responders to treatment (chi2 = 10.025; df = 1; p = 0.002). Overall sensitivity was 48% and specificity 91%. Conventional predictive variables (gender, age, fibrosis and genotype) where combined with HS (5%) and all together achieved Nagelherke R squared of 34.0% in prediction of SVR, with accuracy rate of 75.0%. Further, invasive variables (fibrosis and HS) where replaced with vire mia and body mass index (BMI). All noninvasive variables together achieved Nagelkerke R squared of 26.5% in prediction of SVR with 74% accuracy rate of the logistic regression model. Very low HS (5%) is negative predictor of SVR and can be replaced with noninvasive variables (gender, age, viremia and BMI) with same accuracy rate of the logistic regres- sion model.

Constrictive pericarditis is a rare disease but can cause diagnostic problems. The diagnosis can be even more difficult if combined by pulmonary emobolism. We present the case of constrictive pericarditis complicated with several thromboembolic incidents

The efficacy of rimsulfuron (l5 g ha-1 + 0.1% Sandovit as wetting agent) as single post- emergence application at 3-5 leaf stage of crop ; metolachlor + atrazine (1800 + 1200 g ha-1), pre-emergence ; and metalachlor + atrazine (900 + 600 g ha-1), as pre-emergence band spraying, on dominant weeds in two maize inbred lines ("OS l-44" and "OS 36-l6") were studied at four sites in trials conducted from 1993 to 1995. Rimsulfuron showed good effect on Sorghum halepense (93% control), Echinochloa crus galli, Setaria spp., Amaranthus retroflexus and Chenopodium album (95% control). This herbicide controlled Sorghum halepense at 10-25 cm and at high dry weight of shoots (528 g m-2) more effectively than the treatments that included atrazine. Rimsulfuron was less effective on Polygonum lapathifolium (63-86% control), Ambrosia artemisiifolia (62-73% control) and Abutilon theophrasti (42-60% control). The herbicide did not cause any visible phytotoxicity to the inbred lines. Seed yields increased as a results of all treatments from a weedy control value of 1.96 t ha-1 to 2.74-3.28 t ha-1). Yield increase among herbicide treatments was in the following order: metolachlor+atrazine at the recommended rate >rimsulfuron>metolachlor+atrazine at a reduced rate (References: 13).

When compared to data in larger registries our results are almost the same and in some cases even better. In conclusion TAVI is adequate treatment option for selected patients in Croatia and we strongly encourage performing it even more in the future.

Corn (Zea mays) is the leading culture according to sown area in Croatia. s-Triazines, and atrazine (2-chloro-4-ethylamino-6-isopropylamino-1, 3, 5-triazine) in particular, are most widely used in weed control of corn crops. In Croatia, products of atrazine are used in formulations of pure atrazine or in ready mix combination with other herbicides applied in pre-emergence or post-emergence (Maceljski et al. 2005). Due to its chemical properties, atrazine is characterized by high water mobility and environmental persistence (Kramer et al. 2001). Because of these atrazine properties and its longlasting use as a plant-protecting agent in Croatia, residues of this contaminant have been identified in the samples of surface, ground, and drinking waters (Vidaček et al. 1995 ; Gojmerac et al. 1996). The possible intake of atrazine residues and its dealkylated biodegradation products (de-ethyl atrazine) with drinking water poses a health risk for humans, since the results of previous studies point to the toxic effect of atrazine residues on the reproductive system (Cooper et al. 2000 ; Gojmerac et al. 2004). The objective of this study was to evaluate the results of atrazine monitoring in surface water of the corn-production area of Turopolje (west Croatia), with the soil characterized by high hydraulic conductivity.