SUMMARY 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.

Introduction: Healthcare associated infections (HCAIs) represent a major public health issue. In Europe, 37 000 patients are affected annually by some sort of HCAI. HCAIs are preventable, and hand hygiene is an important measure in their prevention. During daily clinical practice, hands of healthcare workers (HCWs) are exposed to surfaces, various substances and objects; therefore, proper hand hygiene is the first step in preventing microorganism transmission. Aim: To determine the HCWs hand hygiene compliance with the guidelines of the World Health Organization through a systematic review of literature. Methods: A systematic review of literature based on the PRISMA statement guidelines using the PubMed database in a search for articles that evaluate the hand hygiene compliance among HCWs. Results: Six articles were taken into consideration by the availability of full-text articles and years of publication between 2010 and 2020. Results showed that compliance rate was the highest in studies that implemented World Health Organisation’s Multimodal Hand Hygiene Improvement Strategy or its modifications. Conclusion: The multimodal approach, as World Health Organisation’s multimodal strategy or its local modifications, has been shown as the best approach addressing the problem of hand hygiene compliance. Further areas for research include finding a better method of measuring compliance, technology-driven solutions for both delivery of alcohol-based handrub and monitoring of its use, a greater focus on evaluating proper hand hygiene techniques, and insuring longer-term programs of training and education to achieve the best effectiveness of hand hygiene compliance among HCWs.

Studies have documented independent contribution of sympathetic activation to the cardiovascular disease continuum. Hypertension is one of the leading modifiable factors. Most if not all the benefit of antihypertensive treatment depends on blood pressure lowering, regardless how it is obtained. Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of the concurrent use of three antihypertensive drugs of different classes. Ideally, one of the three drugs should be a diuretic, and all drugs should be prescribed at optimal dose amounts. Poor adherence to antihypertensive therapy, undiscovered secondary causes (e.g. obstructive sleep apnea, primary aldosteronism, renal artery stenosis), and lifestyle factors (e.g. obesity, excessive sodium intake, heavy alcohol intake, various drug interactions) are the most common causes of resistant hypertension. Cardio(reno)vascular morbidity and mortality are significantly higher in resistant hypertensive than in general hypertensive population, as such patients are typically presented with a long-standing history of poorly controlled hypertension. Early diagnosis and treatment is needed to avoid further end-organ damage to prevent cardiorenovascular remodeling. Treatment strategy includes lifestyle changes, adding a mineralocorticoid receptor antagonist, treatment adherence in cardiovascular prevention and, in case of failure to control blood pressure, renal sympathetic denervation or baroreceptor activation therapy. The comparative outcomes in resistant hypertension deserve better understanding. In this review, the most current approaches to resistant hypertension and cardiovascular risk based on the available literature evidence will be discussed.

posebnosti anestezije pretilih bolesnika Specific issues in anesthesia of obese patients SAŽETAK: Liječenje pretilosti zahtijeva multidisciplinarni pristup koji uključuje niz dijetetskih mjera, promjenu životnih navika, fizičku aktivnost te upotrebu različitih lijekova. Većina spomenutih mjera, međutim, rezultira ograničenim i kratkotrajnim gubitkom tjelesne mase, što je jedan od razloga zbog kojeg se danas sve više pristupa kirurškom liječenju ili barijatričkoj kirurgiji. Barijatrične su operacije postupci kojima se mijenjaju kapacitet i anatomija probavnog sustava i preporučene su kao metode liječenja pretilosti u osoba s BMI većim od 40 kg/m 2 ili u osoba s BMI većim od 35 kg/m 2 uz pridružene bolesti kao što su arterijska hipertenzija, šećerna bolesti ili kardiorespiracijski poremećaji. SUMMARY:The treatment of obesity requires an interdisciplinary approach that includes a wide range of dietary measures, changes in life habits, physical activity, and the use of various medications. Most of these measures, however, only result in a limited and temporary loss of body mass, which is one of the reasons for an increasing tendency towards resorting to surgical treatment or bariatric surgery. Bariatric procedures change the capacity and anatomy of the digestive system and are recommended as treatment for obesity in persons with a BMI above 40 kg/m 2 or persons with a BMI above 35 kg/m 2 with concomitant diseases such as arterial hypertension, diabetes, or cardiorespiratory disorders.KLJUČNE RIJEČI: pretilost, anestezija, kirurško liječenje.