Objective: Many patients with primary adrenal insufficiency (Addison's disease) take extra doses of glucocorticoids during stressful events, but a benefit has not been demonstrated in controlled trials. Here, we investigated the effects of a pre-exercise hydrocortisone dose on cardiorespiratory, hormonal and metabolic parameters in response to short-term strenuous physical activity. Design: This was a randomized placebo-controlled, cross-over clinical trial. Participants: Ten women with Addison's disease and 10 age-matched healthy females participated in the study. Measurements: All women in the study underwent maximal incremental exercise testing. A stress dose of 10 mg hydrocortisone or placebo was given 1 h prior to exercise on two occasions. Blood samples were drawn before, and 0, 15 and 30 min post exercise. Oxygen uptake, maximal aerobic capacity, endocrine and metabolic responses to physical activity, as well as health status by questionnaires were evaluated. Results: Maximal aerobic capacity and duration of exercise were significantly lower in patients than in healthy subjects and did not improve with the treatment. After an extra hydrocortisone dose serum cortisol was significantly higher than in the healthy subjects (P!0.001). Post-exercise glucose and adrenaline levels were significantly lower and free fatty acids insignificantly higher in patients irrespective of stress dose. Stress dosing did not alter other metabolic or hormonal parameters or quality of life after the exercise. Conclusions: The patients did not benefit from an extra dose of hydrocortisone in short strenuous exercise. Stress dosing may not be justified in this setting. Whether stress dosing is beneficial in other types of physical activity will have to be examined further.
Levels of awareness of aphasia in the Balkans are low and variably associated with age, gender, socio-economic and educational levels. Respondents with some knowledge of aphasia gained it through personal or professional interaction with aphasia or the media. The data provide a basis for awareness raising in Balkan countries to reduce stigmatization, improve community access and understanding. Implications for rehabilitation Awareness of aphasia is low universally, even among healthcare workers. Low public awareness of a condition, like aphasia, results in under-funded research and service provision. In order to raise public awareness of aphasia we need to know how many members of the general public know about it. Improvements in public awareness could positively affect funding, the quality of services, and the public understanding and acceptance of individuals with aphasia in the community. Improving awareness of aphasia in those who come into contact with aphasic people, like healthcare workers, could significantly improve the healthcare experience of people with aphasia and their families.
Summary. Background: The mechanism for post-thrombotic syndrome (PTS), the most important long-term sequelae of deep venous thrombosis, is not entirely known. It is probably caused by venous hypertension due to venous insufficiency and venous obstruction. Venous hypertension could also be a consequence of the May-Thurner syndrome (MTS), i.e. the obstruction of the common iliac vein. The aim of the present study was to explore if women with untreated MTS and a history of proximal DVT develop PTS more frequently. Patients and methods: A cohort of 68 female patients with a history of proximal left-sided DVT in the past were evaluated. According to Villalta score, they were segregated in two groups – with and without PTS (Villalta score ≥ 5 or < 5 points, respectively). For the diagnosis of MTS, magnetic resonance venography was performed. Results: Out of 68 patients, 25 developed PTS (36.8 %). Recurrent DVT, older age, pre-existent chronic venous insufficiency, and shorter compression stockings wearing time were statistically related to PTS. Deep and superficial valve incompetence was also significantly related to PTS, while incomplete thrombus removal showed only a trend towards PTS development. On the other hand, MTS per se turned out not to be linked to PTS. Conclusions: Our study suggests that women with MTS might not develop PTS more often, which puts aggressive treatment of MTS under question. More clinical trials are warranted to further examine this yet not fully explained field.
these units improves outcomes. [3][4][5][6][7][8] Particularly in our country, as in many others, there is an important issue still needed to be ruled out regarding the lack of intensivists. 9 Likewise, cost-effectiveness and cost-usefulness of multidisciplinary teams specifically in charge of treating neurocritical patients has been broadly demonstrated. [10][11][12][13]
Background: Venous thromboembolism (VTE) is the most common unpredictable cause of in-hospital death. Despite the fact that VTE prophylaxis has been proven to be efficacious and safe it remains underused. The aim is to determine the use of VTE prophylaxis in patients admitted to medical wards of the Division of Internal Medicine of the University Medical Centre Ljubljana.Methods: On a pre-specified day, all patients hospitalized on the wards of the Division of Internal Medicine were assessed for VTE risk by Padua prediction score. According to the risk of VTE and contraindications for pharmacological prophylaxis the adequacy of VTE prophylaxis was determined by trained data abstractors. Doctors responsible for the patients’ treatment were not aware of the study.Results: 511 patients were enrolled (222 women and 289 men). VTE prophylaxis was not indicated in 245 patients; 17 (6.9 %) patients classified as being at low risk for VTE nevertheless received prophylaxis. A half of 266 (52.1 %) patients at high risk for VTE had a contraindication to pharmacological prophylaxis. In 133 at-risk patients without contraindications, VTE prophylaxis was prescribed correctly in 50 (37.6 %) patients, 11 (8.3 %) patients received wrong doses and 72 (52 %) at-risk patients did not receive any prophylaxis.Conclusion: On the chosen day, VTE prophylaxis was appropriately used in 81 % of hospitalized patients on medical wards of the Division of Internal Medicine of the University Medical Centre Ljubljana. Since only 37 % of the patients at high risk for VTE received recommended VTE prophylaxis, our data reinforce the rationale to implement measures to improve these results.
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