Background: Childhood maltreatment is associated with the development and maintenance of mental disorders. The purpose of this naturalistic study was (a) to identify different patterns of childhood maltreatment, (b) to examine how these patterns are linked to the severity of mental disorders and (c) whether they are predictive of treatment outcome. Methods: 742 adult patients of a university hospital for psychotherapy and psychosomatics were assessed at intake and discharge by standardized questionnaires assessing depression (Beck Depression Inventory, BDI) and general mental distress (Symptom Check List-90-R, SCL-90-R). Traumatic childhood experience (using the Childhood Trauma Questionnaire, CTQ) and ICD-10 diagnoses were assessed at intake. Results: The patients could be allocated to three different patterns of early childhood trauma experience: mild traumatization, multiple traumatization without sexual abuse and multiple traumatization with sexual abuse. The three patterns showed highly significant differences in BDI, General Severity Index (GSI) and in the number of comorbidity at intake. For both BDI and GSI a general decrease in depression and general mental distress from intake to discharge could be shown. The three patterns differed in BDI and GSI at intake and discharge, indicating lowest values for mild traumatization and highest values for multiple traumatization with sexual abuse. Patients with multiple traumatization with sexual abuse showed the least favourable outcome. Conclusion: The results provide evidence that the severity of childhood traumatization is linked to the severity of mental disorders and also to the treatment outcome in inpatient psychotherapy. In the study, three different patterns of childhood traumatization (mild traumatization, multiple traumatization without sexual abuse, multiple traumatization with sexual abuse) showed differences in the severity of mental disorder and in the course of treatment within the same therapy setting.

Background: Polysubstance use (PSU) is common among patients with cannabis use (CU) and is related to more severe CU problems. However, it is unclear how PSU predicts CU treatment outcomes beyond CU patterns. We examined the frequency, amount, and class of additionally used substances as predictors for primary and secondary outcomes. Methods: We conducted crude and adjusted regression analyses for PSU variables as predictors of remission, abstinence, reduction, and secondary outcomes in 166 help-seeking patients from a randomized clinical trial of CANDIS, a cognitive behavioral treatment program. Results: Patients with recent illegal PSU experienced more difficulties in reducing their CU (B = –1.22, p < 0.001). In contrast, remission rates were slightly higher in patients with a wide variety of last-year-PSU (RD = 0.04, p < 0.001). Amphetamine use predicted poorer outcomes regarding CU-related problems (B = –4.22, p = 0.019), and the use of opiates, inhalants, and dissociative substances predicted poorer physical health outcomes (B = –0.62, p = 0.009; B = –0.96, p = 0.039; B = –1.18, p = 0.007). Conclusions: CU treatment is also effective for patients with moderate PSU. However, treatment effects may be enhanced by addressing specific PSU characteristics as part of a modularized program.

<p>Degenerativne bolesti kičme nastaju kao posledica promena na dinamičkim segmentima kičmenog stuba. Klinički ove promene se mogu manifestovati u vidu radikulopatije, mijelopatije i radikulomijelopatije. Najče&scaron;će primenjivana metoda operativnog lečenja kod ovih pacijenata je prednja cervikalna diskektomija sa fuzijom koja omogućava adekvatnu anatomsku i funkcionalnu restituciju degenerativno promenjene cervikalne kičme. Imajući u vidu da su već kompromitovane nervne strukture u riziku od dodatnih o&scaron;tećenja u različitim fazama operativnog zahvata primena intraoperativnog neurofiziolo&scaron;kog monitoringa je dobila svoje mesto i u hirur&scaron;kim tretmanima degenerativnih oboljenja kičme. Svrha primene neuromonitoringa je da obezbedi povratnu informaciju hirurgu o promenama u funkciji nervnih struktura pre nego &scaron;to dođe do ireverzibilnih o&scaron;tećenja. Na ovaj način moguće je prevenirati nastanak novog ili pogor&scaron;anje postojećeg deficita. Takođe intraoperativni nalazi neurofiziolo&scaron;kih parametara mogu da ukažu na težinu postojećeg oboljenja i da budu prediktori ishoda lečenja. Ciljevi ove doktorske disertacije bili su utvrđivanje faza operativnog zahvata u kojima najče&scaron;će dolazi do promena u neurofiziolo&scaron;kim parametrima, kao i postojanje korelacije nalaza intraoperativnog neurofiziolo&scaron;kog monitoringa sa preoperativnim kliničkim nalazom pacijenta kao i rezultatima procene ishoda nakon prednje cervikalne diskektomije se fuzijom. Ova studija je obuhvatila 30 pacijenata kod kojih je indikovano operativno lečenje degenerativnih promena u vratnom segmentu kičmenog stuba prednjom mikrodiskektomijom sa fuzijom. Preoperativno je izvođen klinički pregled pacijenata i kori&scaron;teni su Numerička skala bola i Upitnik za pacijente sa bolom u vratnoj kičmi, koji su takođe popunjavani na otpustu i mesec dana nakon operacije. U toku hirur&scaron;ke procedure upotrebom intraoperativnog neurofiziolo&scaron;kog monitoringa registrovani su somatosenzorni (SSEP) i motorni evocirani potencijali (MEP), kao i spontana elektromiografija. Kod svih SSEP do&scaron;lo je do statistički značajnog povećanja amplitude (p&lt;0,05), dok je kod desnog n. medianusa zabeleženo i statistički značajno skraćenje latence (p&lt;0,05). Značajne promene se beleže između početka i kraja operativnog zahvata, kao i u fazi uklanjanja intervertebralnog diska kada dolazi do dekompresije. U vrednostima pražne struje potrebne za dobijanje MEP nije bilo statistički značajnih promena izuzev kod m. triceps brachii obostrano. Kod pacijenata sa radikulopatijom vrednost pražne struje za dobijanje mi&scaron;ićnog odgovora je statistčki značajno niža u odnosu na pacijente sa mijelopatijom (p&lt;0,05). SSEP koreliraju sa poremećajem senzibiliteta, refleksnim odgovorom i bolom. MEP koreliraju takođe sa refleksnim odgovorom, dok negativna korelacija sa manuelnim mi&scaron;ićnim testom pokazuje da klinički očuvana gruba mi&scaron;ićna snaga ne mora biti pokazatelj pravog stanja motornog sistema. Preoperativne vrednosti NDI su se statistički značajno smanjile mesec dana nakon operacije (p&lt;0,05). U vrednostima bola postoji statistčki značajna razlika između svih merenje (p&lt;0,008), izuzev između bola na otpustu i mesec dana nakon operacije (p&gt;0,008). Latenca desnog n.medianusa pokazuje negativnu, a amplituda pozitivnu korelaciju sa vrednostima bola mesec dana postoperativno (p&lt;0,05). Povećanje amplitude i skraćenje latence SSEP ukazuje na značajan stepen dekompresije. Stabilnost MEP ukazuje na intraoperativnu očuvanost motornih puteva i da nije do&scaron;lo do novog motornog deficita niti produbljivanja postojećeg. SSEP i MEP koreliraju sa kliničkim nalazom, dok su vrednosti bola i NDI statistički značajno manje nakon operacije. Ovi rezultati ukazuju da klinički nalaz pacijenta korelira sa neurofiziolo&scaron;kim nalazom, kao i da introperativne promene neurofiziolo&scaron;kih parametara mogu biti prediktivni faktor ishoda operativnog lečenja.</p> / <p>Degenerative spinal diseases are consequence of spondylotic changes on dynamic segments of spinal column. These changes can result in different clinical appearances such as radiculopathy, myelopathy and radiculomyelopathy. The most common surgical procedure used in treatment of this group of patients is anterior cervical discectomy and fusion (ACDF) which can provide adequate anatomical and functional restitution of degenerative cervical spine. Considering the fact that already compromised neural structure can be additionally damaged in different stages of surgical procedure, use of intraoperative neurophysiological monitoring (IONM) has role in surgical treatment of degenerative spinal diseases. The aim of use of IONM is to provide real time feedback for surgeon regarding changes in function of neural structures before irreversible damage occurs. This is the way to prevent new neurological deficit from occurring or to prevent worsening of preexisting deficit. Results of intraoperative monitoring can additionally emphasize severity of disease and help in outcome assessment. The aim of this doctoral thesis was to determine phases of surgical procedure in which changes in neurophysiological parameters occurs most commonly. Another aim was to determine correlation between findings of intraoperative neurophysiological monitoring and clinical assessment and outcome prediction in patients treated with anterior cervical discectomy with fusion. Thirty patients who met inclusion criteria were enrolled in this study. All of them were treated surgically due to degenerative changes of cervical spine and ACDF were performed in all cases. Patients were thoroughly examined before surgery. Detailed neurological examination were performed together with Numeric pain rating scale (NPRS) and Neck Disability index (NDI) questionnaire. NPRS and NDI were applied on discharge from the hospital and one month after surgery. During surgery we registered somatosensory evoked potentials (SSEP), motor evoked potentials (MEP) and spontaneous elektromiography. In all SSEP there were statistically significant increase in amplitude (p&lt;0.05), while in the case of right n. medianus statistically significant shortening of the latency (p&lt;0.05) was recorded. Significant changes are recorded between beginning and the end of the surgical procedure, as well as in the phase of removing of the intervertebral disc when decompression occurs. In the threshold intensity needed to elicit the MEP there were no statistically significant changes except for m. triceps brachii bilaterally. In patients with radiculopathy, the value of the stimulus intensity needed for obtaining muscular response was statistically significantly lower in comparison with patients with myelopathy (p&lt;0.05). SSEP showed the best correlation with sensory disorder, tendon reflexes and pain. MEPs also correlate with tendon reflexes, while a negative correlation with a manual muscle strength testing results shows that clinically preserved muscle strength does not have to be reliable indicator of the motor system condition. Preoperative NDI values were statistically significantly reduced a month after surgery (p&lt;0.05). In pain values there is a statistically significant difference between all measurements (p&lt;0.008), except between pain on release and a month after surgery (p&gt;0.008). The right n.medianus latency shows a negative, and the amplitude shows positive correlation with pain values one month postoperatively (p&lt;0.05). Increasing amplitude and shortening latency of the SSEP indicates a significant degree of decompression. The stability of the MEP indicates the intraoperative preservation of motor pathways and absence of both new motor deficiency or worsening of the existing one. SSEP and MEP correlate with clinical findings, while pain and NDI values are statistically significantly less after surgery. These results indicate that clinical findings in the patients correlate with the neurophysiological findings. Results also points out that the intraoperative changes in neurophysiological parameters can be a predictive factor for the outcome of surgical treatment.</p>

No description available.

Hintergrund: Schwindel ist ein häufig vorgetragenes Symptom beim Hausarzt. Seine erhöhte Vergesellschaftung mit Ängstlichkeit und Depressivität ist aber bisher zu wenig untersucht worden, ebenso wenig ist dieser Zusammenhang Gegenstand der hausärztlichen Behandlung von Schwindelpatienten. Zielstellung: Kommen unbekannte psychische Hintergründe in Kombination mit Schwindel im hausärztlichen Patientengut häufiger vor als ohne Schwindel? Ergeben sich daraus als Konsequenz unterschiedliche Versorgungsformen durch den Hausarzt? Wie verhält es sich mit deren subjektiven Gesundheitszustand, dem Erfolg der hausärztlichen Behandlung, dem ihnen entgegengebrachten Verständnis und der Häufigkeit der Arztbesuche der Betroffenen? Studiendesign: Prospektive Multicenterstudie in der Allgemeinpraxis Untersuchungsregion: Zehn Hausarztpraxen in Halle a.d. Saale und Nordsachsen/ Leipzig im städtischen und ländlichen Einzugsbereich, welche von Fachärzten für Allgemeinmedizin geführt wurden. Methodik: Die Studie untersuchte insgesamt 590 zufällig am Untersuchungstag eintreffende Patienten in jeweils einer von insgesamt zehn Hausarztpraxen. Die Ausprägung von Schwindelbeschwerden und eventuell vorhandene Merkmale von Ängstlichkeit und Depressivität beim jeweiligen Patienten wurden mit Elementen des Gießener Beschwerdebogens 24 und der Hospital Anxiety and Depression Scale (deutsche Version) untersucht. Ergebnisse: Die Patienten wurden in eine Gruppe mit relevanten (29,7%, n=175) und in eine Gruppe ohne relevante Schwindelbeschwerden (70,3%, n=408) eingeteilt (Cut off >=8 nach GBB 24). Die Gruppe mit relevantem Schwindel wies häufiger Merkmale für Ängstlichkeit (p<0,001) und Depressivität (p<0,001) in allen Altersgruppen auf, zeigte sich unzufriedener mit ihrem Behandlungserfolg (p=0,004), schätzte ihren aktuellen Gesundheitszustand schlechter ein (p<0,001) und konsultierte ihren Hausarzt in den letzten zwölf Monaten häufiger (p=0,020). Sie stellten sich nach ICPC-2 häufiger wegen neurologischer (p<0,001), psychologischer (p=0,026) und unspezifischer Beschwerden (p<0,001) vor. Sie erhielten mehr Diagnosen aus den ICD-10-Kapitel V (Psychische und Verhaltensstörungen) (p=0,030). Diese Patienten waren nach HADS-D auch häufiger psychisch auffällig (p<0,001). Relevanter Schwindel kam bei Frauen aller Altersgruppen häufiger vor als bei Männern (p<0,001). Dennoch ergaben sich keine Behandlungsunterschiede durch die Hausärzte zwischen beiden Gruppen (p=0,101 bis 0,930 je nach ärztlicher Maßnahme). Schlussfolgerung: Schwindelpatienten weisen häufger Ängstlichkeit und Depressivität auf, welche den Schwindel unterhalten. Dieser Zusammenhang sollte in der Sprechstunde bedacht werden. Die psychischen Hintergründe sollten vom Hausarzt aufgedeckt und behandelt werden. Dadurch könnte der Schwindel und damit der subjektive Gesundheitszustand der betroffenen Patienten verbessert und die Inanspruchnahme des Gesundheitswesens verringert werden.

<p>Uvod: Hronični subduralni hematom (HSDH) je učestala i nezanemarljiva traumatska/netraumatska intrakranijalna lezija, naročito kod pacijenata starije životne dobi. Simptomi pacijenata sa HSDH su raznovrsni i često pogre&scaron;no protumačeni i lečeni. Zbog navedenih činjenica, HSDH predstavlja veliki izazov u dijagnostici i terapiji. Različiti autori ističu značaj radiolo&scaron;kih parametara tokom dijagnostike ovog oboljenja i povezanost sa kliničkom slikom I neurolo&scaron;kim statusom pacijenta, pa je ovo istraživanje bilo usmereno u preciznoj evaluaciji pomenutih parametara, njihovoj prediktivnoj vrednosti i uticaju na prognozu ishoda lečenja. Cilj: Generalni cilj istraživanja je bio da se ispita učestalost pacijenata sa hroničnim subduralnim hematomom na teritoriji Vojvodine u periodu od tri godine; da se analizira starosna dob pacijenata, polna distribucija oboljenja, uticaj komorbiditeta ili faktora rizika na nastanak HSDH; prisustvo ili odsustvo traume koja je doprinela nastanku HSDH, vremenski interval od traume do pojave simpotoma ili znakova bolesti i da se omogući praćenje efekta terapije pacijenata sa ovim oboljenjem. Specifični ciljevi su obuhvatili: 1. Da se utvrde parametri kompjuterizovane tomografije koji imaju prediktivni značaj u pozitivnom ishodu lečenja pacijenata sa hroničnim subduralnim hematomom. 2. Da se utvrde klinički parametri koji imaju prediktivni značaj u pozitivnom ishodu lečenja pacijenata sa hroničnim subduralnim hematomom. 3. Da se dobije model sa najvećom specifično&scaron;ću i senzitivno&scaron;ću za predikciju ishoda lečenja, kombinacijom kliničkih i parametrara kompjuterizovane tomografije kod pacijenata sa hroničnim subduralnim hematomom. Materijal i metode: Istraživanje je obavljeno kao prospektivna trogodi&scaron;nja studija u periodu od aprila 2010. do aprila 2013. godine u Kliničkom Centru Vojvodine- Centru za radiologiju i Klinici za neurohirurgiju i obuvatila je 83 pacijenata sa dijagnozom hroničnog subduralnog hematoma. Svi ispitanici su dijagnostikovani upotrebom kompjuterizovane tomografije glave (CT) i lečeni na Klinici za neurohirurgiju KCV. Izvori podataka su celokupna medicinska dokumentacija svakog pacijenta od perioda prve hospitalizacije do njihovog otpusta, a uključuje i podatke vezane za subjektivni osećaj o zdravstvenom stanju koje su pacijenti usmeno izneli &scaron;est meseci nakon hospitalnog otpusta. Rezultati: Rezultati istraživanja pokazuju da je Glasgow Coma Scala (GCS) tj. nivo svesti pacijenta na hospitalnom prijemu jedini parametar sa visokom prediktivnom vredno&scaron;ću za klinički ishod lečenja pacijenata sa HSDH procenjen preko Glasgow Outcome Scale (GOS). Preostali radiolo&scaron;ki i klinički parametri (&scaron;irina hematoma, pomeraj mediosagitalne linije, denzitet hematoma, starost pacijenta) nemaju visoku prediktivnu vrednost za klinički ishod pacijenata sa hroničnim subduralnim hematomom. Zaključak: Na osnovu grupe analiziranih pacijenata sa HSDH nije bilo moguće napraviti optimalan model za predikciju ishoda lečenja kombinujući radiolo&scaron;ke i kliničke parametre. Pojedinačno posmatrani radiolo&scaron;ki parametri nisu imali visoku prediktivnu vrednost za ishod lečenja pacijenata sa HSDH. Izolovan klinički parametar- GCS- je jedini visoko prediktivni faktor za ishod lečenja pacijenata sa HSDH. Kombinacija kliničkih i radiolo&scaron;kih parametara daje visoku vrednost predviđanja kliničkog ishoda lečenja, ali samo zahvaljujući izrazito visokoj prediktivnoj vrednosti GCS. Iz svega navedenog, kompjuterizovana tomografija (CT) ima veliki značaj u ranoj dijagnostici i praćenju terapije pacijenata sa HSDH, ali CT parametri ponaosob nemaju značaj u predviđanju ishoda lečenja.</p> / <p>Introduction: Chronic subdural hematoma (CSDH) is common traumatic/no traumatic intracranial lesion, especially in older patients. Symptomatology of this disease is variable and often is misdiagnosed and treated with specially challenges in diagnostic and therapy. Different authors pointed on importance of radiological parameters during diagnostic of this disease and connections with clinic and neurological status in patients with chronic subdural hematoma (CSDH), so this thesis was directed to evaluate radiological and clinical parameters of CSDHs and to show their predictive values and their significance on patient&rsquo;s outcome. Aim: General aim of this thesis was to examine frequency of patients with chronic subdural hematoma in Vojvodina, during the period of three years, to analyze the age of population with CSDHs, the gender distribution, an impact of comorbidity or risk factors for patients with CSDHs, the presence or absence of trauma which has contributed to CSDH, to determine time interval from trauma to appearance of symptoms and signs of disease, monitoring the effect of therapy. Specific aims were: 1. To determine clinical parameters with a positive predictive significance on patients outcome 2. To determine radiological parameters with a positive predictive significance on patients outcome 3. To determine optimal prognostic model with high specificity and sensitivity, using combination of radiological and clinical parameters for positive prediction outcome. Material and methods: The study was performed as three-year prospective study from April 2010 to April 2013 in Clinical Centre of Vojvodina, Centre for Radiology and Clinic of Neurosurgery and includes 83 patients with chronic subdural hematoma. All patients were diagnosed using computed tomography of the brain (CT scan) and all were treated in Clinic of Neurosurgery (KCV). Data sources included the medical records of each patient from the time of first hospitalization to period of their discharge and included data related to the subjective feeling of the health that patients verbally present six months after hospital discharge. Results: The results showed that the Glasgow Coma Scale (GCS) - a level of consciousness of the patient on the hospital admission was the only parameter with a high predictive value for clinical outcome of patients with CSDH assessed through Glasgow Outcome Scale (GOS). Other evaluated radiological and clinical parameters (width of the CSDH, mediosagital line displacement, a density of the CSDH, the age of the patient) did not have high predictive values for the clinical outcome in patients with chronic subdural hematoma. Conclusion: Based on the analyzed group of patients with CSDH it was not possible to make optimal predictive model for outcome by combining radiological and clinical parameters. Radiographic parameters did not have high predictive values for treatment outcome in patients with CSDH. Glasgow Coma Scale (GCS) is the only highly predictive factor for treatment outcome in patients with CSDH. The combination of clinical and radiological parameters gives high predictive value for clinical outcome, but only because of extremely high predictive value of GCS. Therefore, computed tomography (CT) is of great importance in early diagnosis and therapy monitoring of patients with CSDH, but CT parameters did not have the high predictive values for the patient&rsquo;s clinical outcome.</p>

<p>U savremenoj hirurgiji imperativ je da hirur&scaron;ka procedura bude efikasna, ali i da obezbedi kvalitetan i brz oporavak. Najbitniji segment operativnog lečenja je obezbediti maksimalan učinak kako bi se osobi omogućio brz i potpun povratak aktivnostima dnevnog života. Posebno je pojačano&nbsp;&nbsp; interesovanje za rekonstrukciju prednjeg ukr&scaron;tenog ligamenta kod mlađe i sporsko aktivne populacije. Trendovi u medicini kao i u ortopedskoj hirurgiji idu u pravcu smanjenja postoperativnog krvarenja, bola i skraćenja postoperativnog oporavka. Supstancija sa antifibrinolitičkim delovanjem, kao &scaron;to je traneksamična kiselina, svakako je na&scaron;la svoje mesto u smanjenju postoperativnog krvarenja. Ciljevi istraživanja su se odnosili na utvrđivanje uticaja lokalno aplikovane traneksamične kiseline tokom rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena na postoperativno krvarenje, posmatrane laboratorijske parametre, mere obima kolena, učestalosti postoperativnih komplikacija i kvaliteta postoperativnog oporavka između dve grupe ispitanika (ispitivana i kontrolna grupa). Studija je bila eksprimentalnog karaktera i sprovedena je u Kliničkom centru Vojvodine u Novom Sadu uz odobrenje etičke komisije. U istraživanje, metodom slučajnog izbora, bila su uključena 124 ispitanika oba pola raspoređena u dve grupe (ispitivana i kontrolna), a kod kojih je indikovana operativno zbrinjavanje prekida prednjeg ukr&scaron;tenog ligamenta kolena i koji su dali pristanak da budu uključeni u studiju. Svi prikupljeni podaci su beleženi u protokol, koji je za ovo istraživanje posebno dizajniran. Ispitanici su bili podvrgnuti operativnom zahvatu, uz primenu op&scaron;te ili spinalne anestezije, sa postavljenom pneumatskom poveskom na operisanom ekstremitetu. Ispitivanoj grupi bilo je lokalno aplikovano 20 ml traneksamične kiseline, dok je u kontolnoj grupi na isti način aplikovano 20 ml NaCl 0,9 % rastvora. Postoperativni gubici krvi su praćeni i beleženi tokom 24 h od operacije, dok su laboratorijki nalazi uzorkovani preoperativno i sedmog postoperativnog dana. U posmatranom periodu (preoperativno, sedmog postoperativnog dana, treće i &scaron;este postoperativne nedelje) kod ispitanika je praćen obim kolena i pojava komplikacija (hematom, hemartroza). Nakon sprovedenog istraživanje, prikupljeni podaci su dokumentovani i statistički obrađeni. Rezultati istraživanja jasno ukazuju da postoji statistički značajna razlika (t=7.181, p&lt;0.001) u količni postoperativnog krvarenja između grupa. Prosečno postoperativno krvarenje u ispitivanoj grupi je bilo 71.29&plusmn;40.76 ml, u odnosu na kontrolnu grupu gde je postoperativno krvarenje iznosilo 154.35&plusmn;81.45 ml. U kontrolnoj grupi, postoperativno se beleže niže vrednosti hemoglobina (t=9.608, p&lt;0.001) i hematokrita (t=8.325, p&lt;0.001), i vi&scaron;e vrednosti trombocita (t=2.201, p=0.032) nego u ispitivanoj grupi. Podaci o postoperativnom bolu ispitanika govore u prilog statistički značajnoj razlici u jačini bola prve nedelje nakon operacije između ispitivane i kontrolne grupe (t=2.405, p=0.018) i treće nedelje nakon operacije (t=3.700, p&lt;0.001). U ispitivanoj grupi zabeležena je ređa pojava hematoma 6.45% (n=4), dok je u kontrolnoj grupi 19.35% (n=12). Svi pacijenti u uzorku su popunili upitnik o postoperativnom kvalitetu oporavka. Nije zabeležena statistički značajna razlika u kvalitetu postoperativnog oporavka nakon operacije između dve analizirane grupe ispitanika. Dobijeni rezultati o postoperativnom krvarenju, nakon aplikovane traneksamične kiseline, ukazuju na efikasnost leka i pri lokalnoj primeni tokom rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena. S obzirom na insuficijentnost podataka, ovo ispitivanje stvara &scaron;iru osnovu za dalja istraživanja.</p> / <p>In modern surgery, we need an effective surgical procedure, which provides quality and rapid recovery. The most important segment of surgical treatment is to provide maximum impact to allow a person to return quickly and fully to the activities of daily living. There has been particular interest in the reconstruction of the anterior cruciate ligament in the younger and sport active population. Trends in medicine, as well as in orthopedic surgery, are heading towards reducing postoperative bleeding, pain, and postoperative recovery. A substance with antifibrinolytic activity, such as tranexamic acid, has certainly found its place in reducing postoperative bleeding. The objectives of the study were to determine the effect of locally applied tranexamic acid during the reconstruction of the anterior cruciate knee ligament on postoperative bleeding, observed laboratory parameters, measures of knee circumference, frequency of postoperative complications, and quality of postoperative recovery between the two groups of subjects (study and control group). The study was prospective, conducted at the Clinical Center of Vojvodina in Novi Sad with the approval of the ethics committee. The study, by random selection method, included 124 subjects of both sexes, divided into two groups (tested and control), which indicated operative management of the anterior cruciate ligament rupture and gave informed consent for inclusion in the study. All data collected were recorded in a protocol, which was specifically designed for this research. Subjects underwent surgery, with general or spinal anesthesia, with pneumatic attachment placed on the extremity undergoing surgery. The test group was given topically 20 ml of tranexamic acid, while the control group was administered 20 ml in the same way. NaCl 0.9% solution. Postoperative blood losses were monitored and recorded within 24 h of surgery, while laboratory findings were sampled preoperatively and on the seventh postoperative day. During the observed period (preoperatively, on the seventh postoperative day, on the third and sixth postoperative weeks), the knee volume and the occurrence of complications (hematoma, hemarthrosis) were monitored in the subjects. Following the survey, the data collected were documented and statistically processed. The study results indicate that there was a statistically significant difference (t = 7.181, p &lt;0.001) in the amount of postoperative bleeding between groups. The mean postoperative bleeding in the study group was 71.29 &plusmn; 40.76 ml, compared to the control group where postoperative bleeding was 154.35 &plusmn; 81.45ml. In the control group, lower hemoglobin values (t = 9.608, p &lt;0.001) and hematocrit (t = 8.325, p &lt;0.001) were observed postoperatively, and higher platelet counts (t = 2.201, p = 0.032) than in the study group. The data on the postoperative pain of the respondents support a statistically significant difference in the severity of pain on the first week after surgery between the study and the control group (t = 2.405, p = 0.018) and the third week after surgery (t = 3.700, p &lt;0.001). In the study group, the incidence of hematoma was less than 6.45% (n = 4), while in the control group it was 19.35% (n = 12). All patients in the sample completed a questionnaire on postoperative quality of recovery. There was no statistically significant difference in the quality of postoperative recovery after surgery between the two analyzed groups of subjects. The results of post-operative bleeding, after administrated tranexamic acid, indicate the efficacy of the drug and at a local application during the reconstruction of the anterior cruciate ligament. Due to the insufficiency of data, this study creates a broad basis for further research.</p>

OBJECTIVE: Complaints of cognitive changes are often expressed by patients at all stages of HIV infection. Such changes include decreased memory and attention span, diminished concentration, apathy, and "slowing." Methylphenidate (MPD) has been used in several clinical studies in men with late-stage HIV disease in an attempt to ameliorate these difficulties. The objectives of this review article are to review salient psychopharmacological characteristics of MPD and to describe the research and clinical literature supporting the use of MPD in patients at all stages of HIV infection. METHODS: Seven studies, case reports, or abstracts from International Conferences on AIDS were available in the English literature through August, 1993, directly addressing the use of MPD in patients with HIV disease. Twenty-nine papers were reviewed for pharmacokinetic data, eighteen for safety and side effects issues, and seventeen for relevant contributions from the neuropsychological testing literature. RESULTS: Studies in clinical settings have used doses ranges from 10-90 mg. per day in two or three divided doses with reportedly good results in improving both affective and cognitive symptoms associated with HIV disease. Side effects have been relatively mild and patient satisfaction with treatment has been high. However, no studies have been conducted in early stage HIV disease, where a significant minority of patients have similar complaints in the absence of clinically apparent immunosuppression. Likewise, placebo-controlled, dose-finding studies in AIDS patients are entirely lacking, and no studies in women with HIV disease and cognitive changes have been published. CONCLUSIONS: In spite of these important research short-comings, clinical experience with MPD treatment of cognitive changes in men with HIV/AIDS is consistent with the notion that this medication holds significant promise to improve the quality of life for persons living with HIV/AIDS. Controlled studies to test this hypothesis are warranted.

BACKGROUND: Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. OBJECTIVE: The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. METHODS: A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. RESULTS: Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. CONCLUSIONS: This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers. TRIAL REGISTRATION: ClinicalTrials.gov NCT04004260; https://clinicaltrials.gov/ct2/show/NCT04004260.

BACKGROUND: Current guidelines give class I recommendations for uninterrupted use of dabigatran rivaroxaban as an alternative to vitamin K antagonist (VKA) in patients of atrial fibrillation (AF) who are undergoing catheter ablation. The recent randomized controlled trials have shown similar efficacy of novel oral anticoagulants when compared to VKA in these patients. We sought to perform a meta-analysis with a focus on subgroup analysis of novel oral anticoagulants. METHODS: We searched PubMed, Clinical trials registry and the Cochrane Center Register of Controlled Trials were searched through August 2020. Six RCTs studies (n = 2260) comparing the use of NOACs versus VKA in patients with AF undergoing catheter ablation were included. The odds ratio (OR) with 95% confidence interval was computed and P < 0.05 was considered as a level of significance. Major adverse cardiac events (MACE) were considered as a primary endpoint. RESULTS: Our results showed a significant difference in MACE between NOACs and VKA [OR 0.57 (0.37-0.88); P = 0.01] and in major bleeding events [OR 0.55 (0.35-0.86); P = 0.009], which is mainly derived from the use of dabigatran. No significant difference in MACE or major bleeding events was found on the subgroup analysis of rivaroxaban and apixaban over VKA therapy. CONCLUSION: Uninterrupted use of NOACs is safe and effective alternative for the prevention of cerebral thromboembolism and reducing the risk of major bleeding in patients undergoing catheter ablation of AF. However, the individual subgroup analysis showed that only dabigatran is superior to VKA in terms of reducing MACE through a reduction in major bleeding. The rivaroxaban, apixaban and edoxaban are non-inferior to VKA therapy based on these results. Further studies are needed to generalize these recommendations in morbidly obese patients.