Urine high-sensitive troponin I in children cannot offer an applicable alternative to serum.

Introduction: In children, congenital heart defects represent the primary cause of increased serum troponin I. The elimination process of cardiac troponin I from the bloodstream and the factors influencing this process remain unknown. The objective of this study was to explore the role of troponin I as an indicator of cardiac damage in children both in serum and urine, a concept previously investigated in adults. Methods: Our prospective study involved 70 children under 24 months of age. The first group underwent ventricular septal defect repair, while the second group involved children who had undergone partial cavopulmonary anastomosis. For these groups, urine and serum troponin I were assessed on four occasions. The third group, consisting of healthy children, underwent a single measurement of urine troponin I. Results: Serum troponin I values exhibited an expected elevation in the early postoperative period, followed by a return to lower levels. Significantly higher concentrations of serum troponin I were observed in the first group of children (p < 0.05). A positive correlation was found between troponin I in the first three measurements and cardiopulmonary bypass and aortic cross-clamping time. There was no discernible increase in urine troponin I directly related to myocardial damage; troponin I couldn't be detected in most urine samples. Discussion: The inability to detect troponin I in urine remains unexplained. Potential explanatory factors may include the isoelectric point of troponin I, elevated urinary concentrations of salts and urea, variations in urine acidity (different pH levels), and a relatively low protein concentration in urine.

Low Level of First Morning Urine Cardiac Troponin I: A Specific Hallmark of Aortic Stenosis Severity.

Background: It has recently been shown that cardiac-specific troponin I concentrations in first morning urine samples can be measured with commercially available tests. Due to their accumulation in the first morning urine, scientific papers indicate a potential predictive value for cardiovascular diseases. Therefore, the aim of this study was to compare the concentration of cardiac troponin I in the first morning urine in patients with severe aortic stenosis and the healthy population. Patients and Methods: Blood and first morning urine samples were collected from 34 healthy individuals (17 female) at University Hospital Merkur and 25 patients with severe aortic stenosis (14 female) before surgical treatment at University Hospital Dubrava. Cardiac troponin I and T values were determined using high-sensitivity assays using commercially available Abbott and Roche tests. Results: Patients with severe aortic stenosis had significantly lower troponin I concentrations in the first morning urine samples (0.3 ng/L (0.1-0.6)) as compared to the healthy population (15.2 ng/L (8.4-19.9)) (p < 0.001). There was no statistically significant difference in troponin T concentrations between healthy individuals and patients with severe aortic stenosis. In parallel, both I and T plasma troponin concentrations were significantly higher in patients with severe aortic stenosis. Conclusions: In patients with severe aortic stenosis, cardiac troponin I values in the first morning urine are significantly lower than in healthy subjects.

Patients with Type 2 Diabetes, Higher Blood Pressure, and Infrequent Fundus Examinations Have a Higher Risk of Sight-Threatening Retinopathy.

Background: Diabetic retinopathy (DR) is the most common cause of preventable blindness among working-age adults. This study aimed to evaluate the impact of the regularity of fundus examinations and risk factor control in patients with type 2 diabetes (T2DM) on the prevalence and severity of DR. Methods: One hundred and fifty-six T2DM patients were included in this cross-sectional study. Results: In this sample, the prevalence of DR was 46.2%. Patients with no DR mainly did not examine the fundus regularly, while most patients with mild/moderate nonproliferative DR (NPDR) underwent a fundus examination regularly. In 39.7% of patients, this was the first fundus examination due to diabetes, and 67% of them had sight-threatening DR (STDR). Diabetes duration (p = 0.007), poor glycemic control (HbA1c) (p = 0.006), higher systolic blood pressure (SBP) (p < 0.001), and diastolic blood pressure (DBP) (p = 0.002) were the main predictors of DR. However, the impact of SBP (AOR 1.07, p = 0.003) and DBP (AOR 1.13, p = 0.005) on DR development remained significant even after adjustment for diabetes duration and HbA1c. The DR prevalence was higher in patients with higher blood pressure (≥130/80 mmHg) than in those with target blood pressure (<130/80 mmHg) (p = 0.043). None of the patients with target blood pressure had STDR. The peaks in SBP and DBP were observed in T2DM with DR and the first fundus examination due to diabetes. Conclusions: In this T2DM sample, DR prevalence was very high and strongly related to blood pressure and a lack of regular fundus examinations. These results indicate the necessity of establishing systematic DR screening in routine diabetes care and targeting blood pressure levels according to T2DM guidelines.

In Association with Other Risk Factors, Smoking Is the Main Predictor for Lower Transcutaneous Oxygen Pressure in Type 2 Diabetes.

Type 2 diabetes mellitus (T2DM) significantly increases the risk of peripheral artery disease (PAD), and diabetes is the leading cause of nontraumatic amputations. This study investigated the risk factors for transcutaneous oxygen pressure (TcPO2) in T2DM, a noninvasive method to quantify skin oxygenation and the underlying microvascular circulation. The study included 119 T2DM patients (91 male/28 female). TcPO2 measurements were conducted with the Tina TCM4 Series transcutaneous monitor (Radiometer, Copenhagen, Sweden) and skin electrodes. Patients with TcPO2 < 40 mmHg were younger (p = 0.001), had significantly higher systolic blood pressure (SBP) (p = 0.023), glycated hemoglobin (HbA1c) (p = 0.013), fasting plasma glucose (fPG) (p = 0.038), total cholesterol (p = 0.006), LDL cholesterol (p = 0.004), and had more frequent smoking habits (p = 0.001) than those with TcPO2 ≥ 40 mmHg. The main predictors for the TcPO2 value (R2 = 0.211) obtained via stepwise regression analysis were age, smoking, SBP, HbA1c, fPG, and total and LDL cholesterol. Among all the listed predictors, smoking, HbA1c, and LDL cholesterol were found to be the most significant, with negative parameter estimates of -3.051310 (p = 0.0007), -2.032018 (p = 0.0003), and -2.560353 (p = 0.0046). The results of our study suggest that in association with other risk factors, smoking is the main predictor for lower TcPO2 in T2DM.

Comparison of vitamin K and non-vitamin K oral anticoagulants and the bleeding frequency in the emergency department.

INTRODUCTION: Safety studies of anticoagulant therapy have so far been conducted on many subjects in controlled conditions (i.e., clinically monitored) and demonstrated the noninferiority of new ones over old anticoagulant drugs. Data on the propositions for the presence of symptoms and signs of bleeding among various anticoagulants in the emergency department indicate that these data do not match the data published so far. AIM: The aim of the study was to investigate the differences in the frequency of bleeding and bleeding-related symptoms as a reason for emergency department attendance in patients on anticoagulant therapy. METHODS: The study included patients from the emergency department of University Hospital for one year, who were on anticoagulant therapy and who met the inclusion criteria. Out of a total of 595 patients, 409 were on warfarin (68.74%), and the rest were taking direct oral anticoagulants (DOAC): dabigatran 71 (11.93%), rivaroxaban 66 (11.09%) and apixaban 49 (8.23%). RESULTS: Out of 409 patients taking warfarin, 34.4% were adequately anticoagulated with the frequency of bleeding 13.7%, while in 57.2% of patients, PT INR was higher than the reference values with the frequency of bleeding 15.0%. A comparison between all DOAC groups and adequately anticoagulated warfarin patients in the frequency of bleeding and bleeding-related symptoms as a reason for emergency attendance yielded a difference that was marginally statistically significant (Pearson Chi-Square = 7.554, p = 0.052). CONCLUSION: Monitoring the frequency of bleeding and bleeding-related symptoms in patients on oral anticoagulant therapy as a reason for emergency department attendance may be a new safety and efficacy factor in real-life patient scenarios.

Renal Denervation in the Treatment of Resistant Hypertension and Difficult-to-Control Hypertension - Consensus Document of the Croatian Hypertension League - Croatian Society of Hypertension, Croatian Cardiac Society, Croatian Endovascular Initiative, Croatian Society for Diabetes and Metabolic Diseases, Croatian Renal Association, and Croatian Society of Family Physicians of the Croatian Medical Association.

Renal denervation (RDN) as a method of treating arterial hypertension (AH) was introduced in Croatia in 2012. A multidisciplinary team and a network of hospitals that diagnose and treat patients with severe forms of AH were established, and a very strict diagnostic-treatment algorithm was prepared. At monthly meetings patients with truly resistant hypertension who were candidates for RDN were discussed. According to the 2021 ESH position statement and 2023 ESH guidelines, RDN is considered an alternative and additional, not a competitive method of treating patients with various forms of AH which must be performed by following a structured procedure and the patient's preference should be considered. In view of the changes in the global scientific community, the Croatian Hypertension League brings this consensus document on RDN conducted with radiofrequency-based catheter, the only currently available method in Croatia. In this document, exclusion and inclusion criteria are shown, as well as three groups of patients in whom RDN could be considered. The new diagnostic-treatment algorithm is prepared and follow-up procedure is explained. In Croatia, RDN is reimbursed by the national insurance company, thus pharmacoeconomic analyses is also shown. Criteria required by an individual centre to be approved of RDN are listed, and plans for prospective research on RDN in Croatia, including the Croatian registry for RDN, are discussed.

Prescribers' approval rate of pharmacist-initiated interventions to optimise patients' clinical status of hypertension in the ambulatory care setting.

This perspective, pre- and post-intervention study with a one-year follow-up primarily aimed to ascertain prescribers' approval rate of pharmacists' interventions and clinical status of hypertension following comprehensive medication management (CMM) intervention in the ambulatory care clinic. Between January 2018 and January 2022 overall 100 patients with hypertension and other comorbidities were referred to the CMM services at the Health Centre Zagreb - Centar (HCZC). Out of 275 interventions directed to prescribers, 73.1 % of interventions were approved, 12.4 % were rejected and 14.5 % were not reviewed. The percentage of patients with a blood pressure goal increased from 45 % at the initial consultation to 82.5 % at the patients' latest encounter (p < 0.001). The average number of drug therapy problems (DTPs) per patient totaled 3.53 ± 1.80, where 98 % of patients had one or more DTPs, 48 % had 4 or more DTPs, whereas 26 % had 5 or more DTPs. Sub-therapeutic dosage (32.6 %) and the need for additional drug therapy (30.9 %) were the two most commonly identified DTPs. These results reinforce the need to integrate pharmacy-led services in the primary care setting with the aim of improving patients' health outcomes.

Markers of cardiac injury in patients with liver cirrhosis.

Liver cirrhosis is an increasing public health problem and a major cause of morbidity and mortality. Accordingly, cirrhotic cardiomyopathy, a frequently underdiagnosed condition, is becoming a growing health problem. In the last 20 years, cardioselective biomarkers have been investigated for their diagnostic and prognostic properties for numerous conditions. The aim of this article is to review the literature on the relationship between the most commonly used cardioselective biomarkers (cardiac troponins I and T, N-terminal pro-B-type natriuretic peptide, brain natriuretic peptide, and heart-type fatty-acid binding protein) and the presence, functional stage, and clinical outcomes of liver cirrhosis. Elevated plasma levels of these biomarkers have been reported in patients with liver cirrhosis, and there is mounting evidence on their predictive value for clinical outcomes in this disease. In addition, elevated plasma levels of these biomarkers have been reported in patients before, during, and after liver transplantation, but in fewer studies. Due to their predictive value for clinical outcomes, we advocate the use of these markers in patients with liver cirrhosis and cirrhotic cardiomyopathy, as well as in candidates for liver transplant.

Diagnostic value and utility of commonly used biomarkers of cardiac and renal function in cardiorenal syndromes: a narrative review.

Cardiorenal syndrome (CRS), first defined in 2004 as a consequence of the interactions between the kidneys and other circulatory departments leading to acute heart failure, has since been recognized as a complex clinical entity that is hard to define, diagnose and classify. The framework for the classification of CRS according to pathophysiologic background was laid out in 2008, dividing CRS into five distinct phenotypes. However, determining the timing of individual organ injuries and making a diagnosis of either renal or cardiac failure remains an elusive task. In clinical practice, the diagnosis and phenotyping of CRS is mostly based on using laboratory biomarkers in order to directly or indirectly estimate the degree of end-organ functional decline. Therefore, a well-educated clinician should be aware of the effects that the reduction of renal and cardiac function has on the diagnostic and predictive value and properties of the most commonly used biomarkers (e.g. troponins, N-terminal pro-brain natriuretic peptide, serum creatinine etc). They should also be acquainted, on a basic level, with emerging biomarkers that are specific to either the degree of glomerular integrity (cystatin C) or tubular injury (neutrophil gelatinase-associated lipocalin). This narrative review aims to provide a scoping overview of the different roles that biomarkers play in both the diagnosis of CRS and the prognosis of the disease in patients who have been diagnosed with it, along with highlighting the most important pitfalls in their interpretation in the context of impaired renal and/or cardiac function.

Postoperative Hyperuricemia-A Risk Factor in Elective Cardiosurgical Patients.

Hyperuricemia is a well-known cardiovascular risk factor. The aim of our study was to investigate the connection between postoperative hyperuricemia and poor outcomes after elective cardiac surgery compared to patients without postoperative hyperuricemia. In this retrospective study, a total of 227 patients after elective cardiac surgery were divided into two groups: 42 patients with postoperative hyperuricemia (mean age 65.14 ± 8.9 years) and a second group of 185 patients without it (mean age 62.67 ± 7.45 years). The time spent on mechanical ventilation (hours) and in the intensive care unit (days) were taken as the primary outcome measures while the secondary measure comprised postoperative complications. The preoperative patient characteristics were similar. Most of the patients were men. The EuroSCORE value of assessing the risk was not different between the groups nor the comorbidities. Among the most common comorbidities was hypertension, seen in 66% of all patients (69% in patients with postoperative hyperuricemia and 63.7% in those without it). A group of patients with postoperative hyperuricemia had a prolonged time of treatment in the intensive care unit (p = 0.03), as well as a prolonged duration of mechanical ventilation (p < 0.01) and a significantly higher incidence of the following postoperative complications: circulatory instability and/or low cardiac output syndrome (LCOS) (χ2 = 4486, p < 0.01), renal failure and/or continuous venovenous hemodiafiltration (CVVHDF's) (χ2 = 10,241, p < 0.001), and mortality (χ2 = 5.22, p < 0.01). Compared to patients without postoperative hyperuricemia, elective cardiac patients with postoperative hyperuricemia have prolonged postoperative treatment in intensive care units, extended durations of mechanically assisted ventilation, and a higher incidence of postoperative circulatory instability, renal failure, and death.

Prediabetes, Non-Dipping Profile and Hypertension-A Recipe for Increased Arterial Stiffness.

BACKGROUND: Pulse wave velocity (PWV) is a known predictor of target organ damage, cardiovascular disease and overall mortality. The aim of this study was to compare the PWV values in subjects with prediabetes, a non-dipper profile and arterial hypertension with their values in healthy subjects. METHODS: A total of 301 subjects, aged 40-70 years, without diabetes mellitus were included in this cross-sectional study (150 with prediabetes). They underwent a 24 h ambulatory blood pressure monitoring (ABPM). Subjects were divided into three hypertension groups (A = healthy, B = controlled hypertension, C = uncontrolled hypertension). Dipping status was determined according to ABPM results, and PWV was measured by an oscillometric device. Prediabetes was defined as having 2 separate fasting plasma glucose (FPG) measurements between 5.6 and 6.9 mmol/L. RESULTS: The highest PWV values were found in group C (9.60 ± 1.34 vs. 8.46 ± 1.01 in group B vs. 7.79 ± 1.10 in group A; p < 0.001), in subjects with prediabetes (8.98 ± 1.31 m/s vs. 8.26 ± 1.22 m/s; p < 0.001) and in prediabetic non-dippers among age groups (p = 0.05). In the multivariate regression model age, blood pressure, nocturnal indices and FPG were shown as independent predictors of PWV values. CONCLUSION: Significantly higher PWV values were found in subjects with prediabetes and non-dipping profiles in all three examined hypertension groups.

EARLY TEACHING AND ADOPTION OF VIDEOLARYNGOSCOPY IN EMERGENCY MEDICINE TRAINING.

The aim of this paper is to gather and evaluate available literature about using videolaryngoscopy as a training tool for novice learners and compare it to direct laryngoscopy. Search of the available literature was performed using the MEDLINE database, through the PubMed searching tool. The inclusion criteria were that papers had to be original research and participants had to be novices in the field of airway management. The studies also had to pertain to the topic of using videolaryngoscopy as a training tool, therefore all papers that evaluated performance of videolaryngoscopy in clinical applications or did not pertain to using videolaryngoscopy as a training tool were excluded from this review. Five studies were identified that fitted the inclusion criteria, all of which showed a statistically significant difference in first attempt success at endotracheal intubation in favor of videolaryngoscopy when compared to direct laryngoscopy. One of the studies also demonstrated a faster skill acquisition rate when using videolaryngoscopy. The use of videolaryngoscopy in teaching airway management to trainees (emergency medicine residents included) is a viable option and should be encouraged and researched further.

ARTERIAL HYPERTENSION FOLLOWING COVID-19: A RETROSPECTIVE STUDY OF PATIENTS IN A CENTRAL EUROPEAN TERTIARY CARE CENTER.

The aim of this study was to determine the frequency of newly verified or worsened existing hypertension in patients who had coronavirus 2019 (COVID-19). To be categorized as a COVID-19 patient, a positive reverse-transcription polymerase chain reaction test at a single point in time was required. The patients' age, history, laboratory values and antihypertensive therapy of patients were recorded. In one year, 32 of 199 patients studied had either newly verified (15) or worsened existing (17) arterial hypertension. Among those patients, the median time from a verified infection to the onset of symptoms was 3 months. When the patients were divided into groups, 4 were in the acute, 11 in the sub-acute, 8 in the chronic and 9 in the "long COVID" group. Compared to the rest of the study population, patients presenting with arterial hypertension had significantly higher systolic (median 141 mmHg vs 130 mmHg, p<0.001) and diastolic (median 93 mmHg vs 80 mmHg, p<0.001) blood pressure and were significantly younger (median 51 vs 59 years, p 0.032). Arterial hypertension following COVID-19, either newly verified or worsened existing, is a relatively common occurrence (16% of our patient pool), indicating that more effort should be directed at evaluating the blood pressure values of patients following COVID-19.

CAN'T INTUBATE, CAN'T OXYGENATE: A RARE CASE OF A DIFFICULT AIRWAY DUE TO NONHEREDITARY ANGIOEDEMA.

Angioedema is a form of allergic mediated by histamine and non-allergic mediated by bradykinin and can be lethal if not recognized and treated promptly. This case demonstrates the proper diagnosis of and intervention in rapid onset severe angioedema. A 68-year-old male came to the emergency department with a complaint of dyspnea that started two hours before. He had type II diabetes, chronic kidney disease and several different antihypertensive medications, including an ACE inhibitor for hypertension. During physical examination, the patient was hypertensive, tachycardic, tachypnoic, and edematous. During his stay in the ED he was treated with a combination of corticosteroids, antihistamines and epinephrine, but the patient's edema and dyspnea worsened and his oxygen saturation started to deteriorate with a progression of skin edema. Intubation was not possible due to the large edema of the tongue, so a tracheotomy was done. An ampule of icatibant was administered and rapid regression of the edema, along with the stabilization of the patient's vital signs, followed after five minutes. The patient was discharged home after five days with a recommendation of discontinuing the ACE inhibitor. While non-hereditary angioedema is not a rare condition, emergency physicians should be adequately educated about it.

SYSTEMIC INFECTION WITH SINGLE OR MULTI-ORGAN DAMAGE CAUSED BY INADEQUATELY MANAGED CHRONIC WOUNDS: A CASE SERIES.

Chronic wounds are often underestimated condition with increasingly growing inpatient and outpatient treatment costs. Since the patient population affected by chronic wounds is heterogeneous and includes diabetes, chronic venous insufficiency and peripheral artery disease patients, with additional differences in gender, age, previous medical history, treatment of chronic wounds is highly personalized and dependent on a variety of factors. This paper aims to highlight the problems that the chronic wound patient population is facing during the COVID-19 pandemic: from higher probability of an undesirable disease outcome to the fact that many of them have limited access to primary care providers and to the regular and continuous care that their condition demands. This paper describe three patients with chronic wounds. Each of the patients had a significant worsening of their chronic wounds during the COVID-19 pandemic: either following an active SARS-CoV-2 infection or due to the limited access to primary care. The cases described here highlight the necessity of providing proper and regular care for all patients during the COVID-19 pandemic, regardless of the current state of the healthcare system and the adversities and hurdles it currently faces, to prevent the pandemic from becoming a syndemic.

DIAGNOSIS OF PULMONARY EMBOLISM IN THE EMERGENCY DEPARTMENT.

The aim of this study was to determine the association of clinical presentation, the Wells scoring system and D-dimer values with MSCT pulmonary angiography. A case control study was conducted in the Emergency Department of the Clinical Hospital Sveti Duh throughout 2019. Patients with a referral diagnosis of a pulmonary embolism were included in the study. Patients were divided into two groups. The first group consisted of patients diagnosed with pulmonary embolism by MSCT pulmonary angiography or postmortem, and the second group consisted of patients excluded from pulmonary embolisms. For the Wells score, D-dimers, troponin, respiratory rate and peripheral blood oxygen saturation, statistically significant differences were found between groups of patients with confirmed or excluded pulmonary embolism (p <0.001). For heart rate, chest pain, syncope, and hemoptysis, no statistically significant differences were found between these two groups of patients. Deep venous thrombosis of the lower extremities was found by ultrasound in > 70% of patients with massive a pulmonary embolism. Pulmonary embolism was confirmed in all patients for whom a high risk was calculated according to the Wells score. In conclusion, a low degree of clinical probability (according to the Wells score), along with a normal concentration of D-dimer, are a sure strategy in excluding pulmonary embolism.

BLOOD PRESSURE IS ASSOCIATED WITH DIABETIC RETINOPATHY IN TYPE 1 BUT NOT IN TYPE 2 DIABETES.

The aim of this study was to investigate the role of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the development of diabetic retinopathy (DR) in type 1 and type 2 diabetes and to determine the differences between these two types of diabetes. This cross-sectional study included 84 patients with type 1 diabetes (T1DM) and 107 patients with type 2 diabetes (T2DM). Ophthalmologic retinal examination included indirect slit-lamp fundoscopy, color fundus photography according to EURODIAB (EUROpe and DIABetes) protocol and optical coherence tomography. Blood pressure was measured with a mercury sphygmomanometer after a 10-minute rest period. In T1DM, DR was positively associated with SBP (p = 0.035), HbA1cmedian (p < 0.001) and hypertensive retinopathy (p < 0.001), while in T2DM DR was positively related only to HbA1cmedian (p = 0.021). Binary logistic regression analysis (no DR/DR) showed that diabetes duration and HbA1cmedian were the main predictors of DR in both types of diabetes. In contrast, SBP (OR = 1.05, p = 0.045) and hypertensive retinopathy (OR = 3.75, p < 0.001) were the main predictors/indicators of DR only in T1DM. In conclusion, blood pressure is associated with DR in type 1 but not in type 2 diabetes.

Medication, nocturnal dipping profile and hypertensive emergency / Medicación, perfil de inmersión nocturna y emergencia hipertensiva

INTRODUCTION: the aim of this study was to analyze the medication used by the patients with hypertensive crisis (blood pressure above 180/120mmHg) and its impact on the main risk factors for hypertensive emergency development. METHODS: a total of 233 patients (108 male, 125 female), 184 had hypertensive urgency/ 53 emergency (54.44% /50.95% in women) at the Emergency department during 11 months. Patients were divided in five age groups as decades starting from the age of 40 (mean 65.85 years) and a total ten groups depending on which type of hypertensive medication they were using (ACEi, ARB, BB, CCB, diuretics, moxonidine, and their combinations). RESULTS: by using antihypertensive monotherapy percentage of hypertensive emergencies were 100.00%, 50.00%, 41.66%, 33.33%, 21.05%. Using ACEi + CCB + diuretic significantly decreased the number of emergencies to 0%, 18.47%, 21.05%, 25.00%, 33.33%; but adding beta blocker additionally diminished the risk. Overall 53 patients had no medication (22.75%) and 68 of 233 patients were smokers (29.18%, 63.23% male) of which 36 patients had hypertensive emergency (52.94% of smokers). The biggest number of non-dippers was found in patients who took ARBs, diuretics and/or CCB but the smallest number was shown in patients who took ACEi in combination with moxonidine (-20.07%). 22.02% of smokers were non-dippers (-54.67% nonsmokers). Odds ratio for getting hypertensive emergency in case patient had a non-dipper profile was 4.18 (CI 1.02 ­ 18.89, p < 0.05). Patients taking different medication (or none) did not have increased chance for hypertensive emergency development (OR 1.21, p = NS). We didn't find any differences in the non-dipping profile incidence between genders (72.12% males, 72.83% females). CONCLUSION: combinations of all antihypertensive medication showed benefit over monotherapy. Higher 24-hour and nighttime blood pressure (non-dipping profile) was significantly associated with greater change for developing hypertensive emergency.

INTRODUCCIÓN: el objetivo de este estudio fue analizar la medicación utilizada por los pacientes con crisis hipertensiva (presión arterial superior a 180/120mmHg) y su impacto en los principales factores de riesgo para el desarrollo de la emergencia hipertensiva. MÉTODOS: un total de 233 pacientes (108 hombres, 125 mujeres), 184 tenían urgencia hipertensiva/ 53 emergencia (54,44% /50,95% en mujeres) en el servicio de Urgencias durante 11 meses. Los pacientes fueron divididos en cinco grupos de edad según décadas a partir de los 40 años (media de 65,85 años) y un total de diez grupos según el tipo de medicación hipertensiva que utilizaban (IECA, ARA, BB, BCC, diuréticos, moxonidina y sus combinaciones). RESULTADOS: utilizando monoterapia antihipertensiva el porcentaje de urgencias hipertensivas fue del 100,00%, 50,00%, 41,66%, 33,33%, 21,05%. El uso de IECA + BCC + diuréticos disminuyó significativamente el número de urgencias al 0%, 18,47%, 21,05%, 25,00%, 33,33%; pero la adición de betabloqueantes disminuyó el riesgo. En general, 53 pacientes no tenían medicación (22,75%) y 68 de 233 pacientes eran fumadores (29,18%, 63,23% hombres), de los cuales 36 pacientes tuvieron una urgencia hipertensiva (52,94% de los fumadores). El mayor número de hipertensos no inmersivos se encontró en los pacientes que tomaban ARA, diuréticos y/o BCC, pero el menor número se mostró en los pacientes que tomaban IECA en combinación con moxonidina (-20,07%). El 22,02% de los fumadores no eran hipertensos inmersivos (-54,67% de los no fumadores). El odds ratio para obtener una emergencia hipertensiva en caso de que el paciente tuviera un perfil no inmersivo fue de 4,18 (IC 1,02 - 18,89, p < 0,05). Los pacientes que tomaban una medicación diferente (o ninguna) no tenían mayor probabilidad de desarrollar una emergencia hipertensiva (OR 1,21, p = NS). No se encontraron diferencias en la incidencia de perfil no inmersivo entre géneros (72,12% varones, 72,83% mujeres). CONCLUSIÓN: las combinaciones de toda la medicación antihipertensiva mostraron beneficios sobre la monoterapia. Una mayor presión arterial de 24 horas y nocturna (perfil de hipertensión no inmersiva) se asoció significativamente con un mayor cambio para desarrollar una emergencia hipertensiva.

Healthcare Utilisation and Clinical Outcomes in Older Cardiovascular Patients Receiving Comprehensive Medication Management Services: A Nonrandomised Clinical Study.

The objective of this study was to evaluate the impact of comprehensive medication management (CMM) services on healthcare utilisation and cardiovascular risk factors among older patients with established cardiovascular diseases (CVDs). This quasi-experimental study that was performed at the Croatian primary care ambulatory clinic included patients aged 65 to 80 years. Patients were divided into intervention (65 patients) and control groups (68 patients) and were followed-up for one year. Pharmacists provided face-to-face consultations to patients from the intervention group. Groups were compared with regards to the clinical parameters (blood pressure, HbA1c, LDL, TC) and healthcare utilisation (hospital admission, emergency visits, unplanned GP visits). The CMM intervention significantly improved systolic blood pressure (p = 0.038), diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison with the control group. Patients included in CMM services had statistically and clinically lower systolic (−9.02 mmHg, p < 0.001) and diastolic blood pressure (−4.99 mmHg, p < 0.001) at the end of the study. The number of hospital admissions and unplanned GPs visits were 3.35 (95% CI 1.16−10.00) and 2.34 (95% CI 1.52−3.57) times higher in the control group compared to the intervention group, respectively. This study demonstrated that pharmacists providing CMM services can significantly contribute to better clinical outcomes and lower healthcare utilisation, thus potentially contributing to total healthcare savings.

OUT-OF-HOSPITAL CARDIAC ARREST OUTCOMES - BYSTANDER CARDIOPULMONARY RESUSCITATION RATE IMPROVEMENT.

Approximately 8000 people suffer from an out-of-hospital cardiac arrest (OHCA) in the Republic of Croatia every year. OHCA survival rates generally remain low despite major advances in resuscitation. Its incidence and survival rate are well known in many European countries, but reliable data on OHCA in Croatia are lacking. The aim of the study was to determine survival rate of patients with OHCA in the Republic of Croatia and the importance of the community bystander cardiopulmonary resuscitation (CPR) rates in the survival chain. This prospective observational study performed between October 1, 2017 and December 31, 2017 included all adult patients with OHCA in Croatia who were treated by Emergency Medical Services (EMS). OHCA data were collected from the Croatian Institute of Emergency Medicine database and Utstein cardiac arrest data collection form. Descriptive data presentation was used in the analyses. Data were expressed as absolute frequencies and percentages and central tendency measures. Testing of correlations in return of spontaneous circulation (ROSC) was performed by logistic regression. During the observation period, a total of 1763 adult patients without signs of circulation were assessed by EMS in Croatia and 760 (43%) adult patients were resuscitated by EMS personnel. Outcomes measured in ROSC until emergency department admission were reported in 126 (17%) cases. Shockable rhythm vs. non-shockable rhythm (OR: 5.832, 95% CI: 3.621-9.392; p<0.001) and bystander witnessed cardiac arrest (OR: 8.213, 95% CI: 2.554-26.411, p<0.001) were significantly associated with a higher probability of survival. There was no significant difference in correlation with day or night shift, etiology of cardiac arrest and bystander CPR variables. Survival rate of OHCA patients who received CPR until emergency department admission in Croatia was 17%. A higher survival rate post-OHCA was more likely among patients who received bystander CPR and had shockable rhythm.