Introduction: Acute coronary syndrome (ACS) is one of the m ost common and most dramatic manifestations of ischaemic h eart disease and distinguishing of ACS from non-cardiac chest pain represents a diagnostic challenge. Objective: Determine the frequency of ACS types: NSTEMI, STEMI and unstable angina pectoris (UAP) and examine the frequency and significance of risk factors and cardiospecific enzymes in patients with ACS. Methods: The analysis included patients who were referred from the prehospital level of the Banja Luka Primary Healthcare Centre (Emergency Department and Family Medicine Department) and treated under the ACS diagnosis in the coronary unit of the Cardiovascular Diseases Clinic of the Banja Luka University Clinical Centre of the Republic of Srpska (UCCRS) in the first 6 months of 2011. The study included patients older than 18, with recorded information on their gender, age, smoking status, hypertension, diabetes, obesity and family burden. Values of cholesterol, triglycerides, serum potassium, creatine kinase (CK), CK-MB, cardiac tro - ponin T (cTnT) were measured. Results: The total of 192 patients were referred under the referral diagnosis of ACS and treated in the coronary unit of the CVD Clinic of the Banja Luka UCCRS. At the same time, ACS was confirmed in 178 cases. STEMI was confirmed in 86 patients (48.31 %), NSTEMI in 55 (30.90 %) and UAP in 37 (20.79 %). ACS was statistically significantly more common in men (112 men and 66 women), in particular younger men (average age for men was 62.7 and 69.2 for men and women, respectively) (U = 2.472 x 103, p < 0.001). Among the risk factors, it was found th at smoking was more often associated with STEMI (p = 0.014) and hypertension with UAP (p = 0.041). Among all param eters, all three examined cardiac biomarkers showed statistical significance (p < 0.001), namely: values at STEMI > NSTEMI > UAP. Conclusion: Half of patients with ACS did not have STEMI (which is presumably easy to diagnose). Third of patients with ACS reported atypical symptoms, which further complicates the early recognition of MI without ST elevation. Precaution is needed in women and in elderly. Determination of cTnT should be available in every examination room.
IntroductionThe acute coronary syndrome is a leading cause of heart death among adults. The treatment of such patients begins during the first contact with the doctor who is in most cases neither an internist or cardiologist, but an emergency medicine specialist or general practitioner working in the emergency department. For that reason it is of great importance to educate doctors who will be able to establish a fast and precise diagnosis, start therapy and organize quick transport to the nearest catheterization room or coronary unit.ObjectiveThe primary objective was to measure frequency of patient's visits to the Emergency Department because of an acute coronary syndrome. The Secondary objective was to examine the choice of treatment in pre-hospital conditions.MethodologyThrough the statistical retrospective analysis we collected the data from the Emergency Department protocols for the period between June 1, 2008 and December 31, 2008.ResultsIn 14,986 patients during the six-month period, 343 of them had acute coronary syndrome. Men were more affected ((59.5%) than women (40.5%). Most cases belonged to the age group from 65 to 80 years (39.6%) and prevalence after 50 years shows abrupt growth. According to the diagnoses, most patients had unstable pectoral angina (42%) and then followed stenocardia (31%) and AIM (27%). Other therapy included NTG (22%), antihypertensives (21%), acetyl-salicylic acid (20%), analgesics (13%), antiarrhythmics (4%). Fifty-seven percent of the patients had complications. STEMI was diagnosed in 69% of patients, and most often the anterior wall was involved (35%).ConclusionThe diagnosis of acute coronary syndrome was established in 343 patients based on the clinical image, electrocardiographic changes and level of cardiospecific enzymes (troponin T).
Uvod. Anemija usljed deficita željeza je veoma važan javno-zdravstveni problem i ima veliki uticaj na zdravlje stanovništva. Svjetska zdravstvena organizacija (SZO) procjenjuje da je više od 30% stanovništva anemično, od kojih se 50% može pripisati anemiji usljed nedostatka željeza. Smatra se da su ovi podaci SZO najprecizniji i da su odraz globalne anemije. Zemlje bez obavljenih istraživanja treba ohrabriti da prikupljaju podatke. Baze podataka pružaju pouzdan metod za praćenje napretka ka eliminaciji anemije i efikasnost trenutne strategije za kontrolu anemije. Cilj rada je bio da se utvrdi uticaj generativnog perioda kod žena na pojavu sideropenijske anemije.Metode. Istraživanje je proteklo kao prospektivna, opservaciona, kohortna studija u JZU Doma zdravlja u Banja Luci. Istraživanje je obuhvatilo 236 žena u generativnom periodu i u postmenopauzi. Podaci su prikupljeni na osnovu kliničkog pregleda i laboratorijskih nalaza koji su popunjeni u upitnik dizajniran za potrebe istraživanja. Anketni upitnik je baziran na Kliničkom vodiču za anemiju koji je izdalo Ministarstvo zdravlja i socijalne zaštite Republike Srpske 2009. godine.Rezultati. Žene u generativnom periodu su oboljele od anemije u 79,2% slučajeva, a žene u postmenopauzi u 20,8%. Značajno veći procenat žena generativnog perioda, koje navode da su prihodi njihovog domaćinstva dovoljni za troškove ishrane, se nalazi u kategoriji umjerenog rizika (2-3 faktora rizika za nastanak sideropenijske anemije u generativnom periodu), za razliku od žena čiji prihodi nisu dovoljni za toškove ishrane,a koje se u većem procentu nalaze u kategoriji sa najvećim stepenom rizika.Zaključak. Žene u generativnom periodu u većem procentu oboljevaju od sideropenijske anemije u odnosu na žene u postmenopauzi. Karakteristike generativnog perioda su bile uzrok pojave sideropenijske anemije, jer nije bilo razlike u korištenju namirnica bogatih željezom i socioekonomskom statusu kod žena u generativnom periodu u odnosu na žene u postmenopauzi.
Background/Aim: Coma is the most severe disturbance of consciousness from which the patient cannot wake up and in which there is no verbal and motor response or opening of the eyes. The aim of the research was to establish the frequency of occurrence of coma and the aetiology of coma in the Banja Luka Emergency Department (ED). Also, the goal was to analyse the accuracy of the referral diagnosis and potential factors that can help the doctor in making a correct diagnosis. Methods: A retrospective cross-sectional study was conducted. In the ED database, in the period from January to September 2022, all patients diagnosed with coma have been found. The gender and age of the patient, vital parameters, performed diagnostic methods and therapy were recorded. The referral diagnosis, the department to which the patient was referred, as well as the final diagnosis determined in hospital conditions were recorded. Results: In the period from January to September 2022 there were 95 patients who were diagnosed with coma. The average age of the patients was 67.76 ± 16.56 years, there were 56 (58.9 %) men and 39 (41.1 %) women. Of that number, 41 (43.2 %) patients were diagnosed with hypoglycaemic coma and those patients were treated in the field. Out of 54 patients, 32 (59.3 %) patients had a confirmed referral diagnosis, while 22 (40.7 %) patients had another diagnosis established at the hospital. All patients with suspected intracranial bleeding or stroke were correctly diagnosed and adequately referred, while all patients with a confirmed diagnosis of sepsis and shock were incorrectly referred (ch2 = 30.563, p < 0.001). Conclusion: The most frequent were coma caused by hypoglycaemia and coma caused by brain ischaemia and non-traumatic bleeding, which were adequately recognised and treated and/or referred. Coma caused by sepsis and shock of different aetiology was not recognised as such and was referred to a neurologist, where precious time was wasted. In order to reduce errors in the field, it is necessary to pay more attention to the anamnestic data on diseases and perform a somatic and neurological examination adequately.
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