Factors associated with difficult neuraxial blockade.

Spinal and epidural blocks are common practice in anesthesia and are usually used for various surgical or endoscopic procedures. Correct identification and puncture of the epidural or subarachnoid space determine the success or failure of the technique. Multiple attempts and difficult access to the epidural or subarachnoid space is a frequent problem in operating theaters and may be hazardous due to a number of possible acute or long-term complications. In addition, multiple punctures are associated with increased pain and patient discomfort. The aim of this study was to determine the factors associated with a difficult spinal or epidural block, dependent on the patient (age, gender, height, weight, body mass index, and quality of anatomical landmarks), the technique (type of blockade, needle gauge, and patient positioning), and the provider (level of experience). The study was conducted at the Department of Anesthesiology, Resuscitation, and Intensive Care Unit of University Hospital Osijek (Osijek, Croatia) and it included 316 patients who underwent a range of different surgical procedures in neuraxial blocks. There were 219 cases of first puncture success, while the overall success of neuraxial blocks was 97.5%. Five patients (1.6%) were submitted to the alternative technique, ie, general anesthesia. In three patients (0.9%), neuraxial block was partial so they required supplementation of intravenous anesthetics and analgesics. Furthermore, it was found that first puncture success was associated with younger age (P=0.007), lower weight (P=0.032), and body mass index (P=0.020). Spine deformity (P=0.015), poor identification of interspinous space (P=0.005), recumbent patient position during the puncture (P=0.001), and use of a paramedian approach were associated with first puncture failure. Adequate preoperative prediction of difficulties can help to reduce the incidence of multiple attempts, rendering the technique more acceptable and less risky to the patient, and consequently leading to improvement of medical care quality. The attending anesthesiologist should consider an alternative technique (general anesthesia or peripheral nerve block) for a patient if certain difficulties can be predicted.

Association between socioeconomic status and obesity in children.

The perception of obesity among people has not changed significantly regardless numerous public educational programs. Reasons for obesity pandemics are numerous and complex, but can be mostly resumed to life-style changes. The aim of this research was to determine connection between socioeconomic factors and obesity with children of our region. Study included pupils aged 7-8 from 19 first grades in 8 primary schools in Osijek-Baranya County. Body height and weight were measured and socioeconomic data status were collected. Socioeconomic status included data on marital status, educational level, employment, number of children in the family, kindergarten attendance and urban/rural location and also smoking habits of parents. BMI was calculated as a parameter for obesity assessment according to Croatian reference values. Total of 372 children were measured. There were 6.5% of overweight children (BMI between 90th and 97th percentile) and 2.4% of obese children (BMI above 97th percentile). The prevalence of obese children in our research was 8.9%. Obesity is not influenced by rural/urban residence, marital status of parents, number of children in the family, mother's education, or by parents' smoking habits. Positive correlation between obesity and father's education and parents' unemployment was found. Available literature data, same as our study, did not show consistent association between socioeconomic factors and obesity with children. Contradictory results of different studies can be a result of a small sample, difference in study design and different criteria for defining categories within investigated socioeconomic factor.

Sexual behaviour and condom use as a protection against sexually transmitted infections in student population.

The aim of the study was to determine the differences in sexual behaviour and condom use as a protection against sexually transmitted infections (STI) between the first-year and the last-year students. Data were collected by filling anonymous and consented questionnaire in June of 2011 at University of Josip Juraj Strossmayer in Osijek, Croatia. Out of 857 students in the planned sample, 462 (53.9%) filled out the questionnaire, and 353/462 (76.4%) were sexually active. Data from sexually active students were processed and statistically significant results between first-year and the last-year students were presented. Studied sample consisted of 192/353 (54.4%) first-year students and 161/353 (45.6%) last-year students. Average age of sexual initiation for the first-year students was 17.28 +/- 1.29 years, a for the last-year students 18.45 +/- 2.14 years, and the difference is significant (Man-Whitney test = 10335.00, p < 0.01). First-year students have lower number of sexual partners (chi2 = 28.005, p < 0.01), during relationship they had lower number of intercourses with the third person (2 = 17.947, p < 0.01), and feel that lower number of their friends were already sexually active at the time of their own sexual initiation (chi2 = 18.350, p < 0.01). First-year students more often inform their partners about existing or previous STI (chi2 = 14.476, p < 0.01) and curiosity significantly influenced their decision regarding sexual initiation (chi2 = 8.689, p < 0.05). First-year students more often used condom at their first sexual intercourse (chi2 = 7.275, p < 0.01), and more rarely used withdrawal (chi2 = 6.380, p < 0.05). At their last sexual intercourse, first-year students more often used any kind of protection (chi2 = 3.853, p < 0.05),more often used condom (chi2 = 11.110, p < 0.01) and withdrawal (chi2 = 5.156, p < 0.05), and more rarely used contraceptive pills (chi2 = 4.405, p < 0.05). First-year students more often use condom in a permanent relationship (chi2 = 13.384, p < 0.05), and also plan to use it during following intercourse in the permanent relationship (chi2 = 17.575, p < 0.01). Growing condom use and decreasing risky sexual behaviour among students, as well as other adolescents and young adults needs to be maintained. Youth should learn before sexual initiation that only correct condom use at every sexual intercourse protects them against STI and human immunodeficiency virus (HIV). Sexual education and STI/HIV prevention programmes, positive role of media (television) and civil organisations that communicate with the youth can help that. Such changes among adolescents and young adults should have to be seen in student population as well.

In-hospital cardiac arrest: can we change something?

Cardiac arrest is classified as 'in-hospital' if it occurs in a hospitalised patient who had a pulse at the time of admission. A probability of patient's survival until hospital discharge is very low. The reasons for this are old age, multiple co-morbidity of patients, late recognition of cardiac arrest, poor knowledge about basic life support algorithm, insufficient equipment, absence of qualified resuscitation teams (RTs) and poor organization.The aim of this study was to demonstrate characteristics of in-hospital cardiac arrests and resuscitation measures in University Hospital Osijek. We analysed retrospectively all resuscitation procedures data where anaesthesiology RTs provided cardiopulmonary resuscitation (CPR) during 5-year period.We analysed 309 in-hospital resuscitation attempts with complete documentation. Victims of cardiac arrest were principally elderly patients, neurological (30.4 %), surgical (25.24 %) and neurosurgical patients (15.2 %) with many associated severe diseases. In 85.6 % of the cases, resuscitation was initiated by ward personnel and RTs arrived within 5 min in 67 % of the cases. However, in 14.6 % of the cases resuscitation measures had not been started before RT arrival. We found statistical correlation between lower initial survival rates and length of hospital stay (p = 0.001), presence of cerebral ischemia (p = 0.026) or cardiomyopathy (p = 0.004) and duration of CPR (p = 0.041). Initial survival was very low (14.6 %), and full recovery was accomplished in only eight patients out of 309 (2.59 %).Identification of terminal chronic patients in which the CPR is not reasonable, a better organisation and ward personnel education can contribute to better overall success.

Influence of health education regarding correct diet on anthropometric indexes in children.

Obesity is one of the leading public health issues in the world whose significance lies, not only in its prevalence, but also in its consequences i.e. diseases that gradually develop in obese people. The aim of the study was to determine obesity prevalence among school children and the influence of health education on its prevalence. Study included pupils of 19 first grades in 8 primary schools of Osijek-Baranja County, Croatia. Body weight and height, waist and hip circumference were measured. Parameters for assessing obesity: body mass index (BMI, according to Croatian referral values), waist circumference (WC), waist and hip circumference ratio (WHR) and waist circumference and height ratio (WHtR) were measured. In order to determine whether the health education of pupils and their parents influences children's anthropometric indexes, health education regarding correct diet, obesity and its consequences and the need for life style changes in terms of daily physical activity was conducted in four primary schools. Pupils of other four primary schools were measured as a control group. Prevalence of overweight children according to BMI before education was 8.9% (6.5% of overweight and 2.4% of obese children). In intervention group of children, according to BMI, there was no decrease in proportion of obese after the health education was conducted and prevalence was 2% before and after the education. On the second measurement, pupils in control group showed increase in proportion of obese from 2.9% to 3.5%. According to weight circumference and height ratio before education there were 10.2% of obese children. After six months, there was an increase in proportion of obese to 11.3%. According to this index there was an increase in proportion of obese in all groups of pupils regardless of gender and conducted education. This study shows that in school-based obesity programs it is necessary to apply more intense interventions with another type of methodology; program should be conducted continuously during longer period, otherwise this condition will continue to rise.

Prevalence and level of Listeria monocytogenes and other Listeria sp. in ready-to-eat minimally processed and refrigerated vegetables.

Minimally processed and refrigerated vegetables can be contaminated with Listeria species bacteria including Listeria monocytogenes due to extensive handling during processing or by cross contamination from the processing environment. The objective of this study was to examine the microbiological quality of ready-to-eat minimally processed and refrigerated vegetables from supermarkets in Osijek, Croatia. 100 samples of ready-to-eat vegetables collected from different supermarkets in Osijek, Croatia, were analyzed for presence of Listeria species and Listeria monocytogenes. The collected samples were cut iceberg lettuces (24 samples), other leafy vegetables (11 samples), delicatessen salads (23 samples), cabbage salads (19 samples), salads from mixed (17 samples) and root vegetables (6 samples). Listeria species was found in 20 samples (20 %) and Listeria monocytogenes was detected in only 1 sample (1 %) of cut red cabbage (less than 100 CFU/g). According to Croatian and EU microbiological criteria these results are satisfactory. However, the presence of Listeria species and Listeria monocytogenes indicates poor hygiene quality. The study showed that these products are often improperly labeled, since 24 % of analyzed samples lacked information about shelf life, and 60 % of samples lacked information about storage conditions. With regard to these facts, cold chain abruption with extended use after expiration date is a probable scenario. Therefore, the microbiological risk for consumers of ready-to-eat minimally processed and refrigerated vegetables is not completely eliminated.

Distribution of Chlamydia trachomatis serotypes in clinical urogenital samples from north-eastern Croatia.

The purpose of this study was to determine prevalence of Chlamydia trachomatis (Ct) urogenital infection and its serotype distribution from clinical samples in north-eastern Croatia. During a 3-year period, 2,379 urogenital samples were analyzed by real-time polymerase chain reaction (A group), while 4,846 genital swabs were analyzed by direct fluorescent antibody test (B group). 132 Ct positive specimens were genotyped by omp1 gene sequencing. The prevalence rate of Ct was 3.2 % in A and 1 % in B group. The most prevalent chlamydial genotype was E (44 %), followed by F (33 %), K (11.5 %), G (8 %), J/UW (5.3 %), D-IC (4.4 %), D-B120 (1.8 %), and B/IU, J/IU, Ia/IU (0.9 % each) serotypes. Single-nucleotide polymorphisms (SNPs) of omp1 gene were detected in E, K, and G serotypes. Some of these SNPs (C/T at position 272 and G/A at position 813 in E strain; C/T at position 884 in D strain) might represent novel omp1 variants.