Background: Women make up an increasing proportion of the physician workforce in anaesthesia, but they are consistently under-represented in leadership and governance. Methods: We performed an internet-based survey to investigate career opportunities in leadership and research amongst anaesthesiologists. We also explored gender bias attributable to workplace attitudes and economic factors. The survey instrument was piloted, translated into seven languages, and uploaded to the SurveyMonkey® platform. We aimed to collect between 7800 and 13 700 responses from at least 100 countries. Participant consent and ethical approval were obtained. A quantitative analysis was done with c 2 and Cramer's V as a measure of strength of associations. We used an inductive approach and a thematic content analysis for qualitative data on current barriers to leadership and research. Results: The 11 746 respondents, 51.3% women and 48.7% men, represented 148 countries; 35 respondents identified their gender as non-binary. Women were less driven to achieve leadership positions (P<0.001; Cramer's V: 0.11). Being a woman was reported as a disadvantage for leadership and research (P<0.001 for both; Cramer's V: 0.47 and 0.34, respectively). Women were also more likely to be mistreated in the workplace (odds ratio: 10.6; 95% confidence interval: 9.4e11.9; P<0.001), most commonly by surgeons. Several personal, departmental, institutional, and societal barriers in leadership and research were identified, and strategies to overcome them were suggested. Lower-income countries were associated with a significantly smaller gender gap (P<0.001). Conclusions: Whilst certain trends suggest improvements in the workplace, barriers to promotion of women in key leadership and research positions continue within anaesthesiology internationally.

In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.

Nutrition support in pediatric intensive care is an integral part of a complex approach to treating critically ill children. Smaller energy reserves with higher metabolic demands (a higher basal metabolism rate) compared to adults makes children more vulnerable to starvation. The nutrition supportive therapy should be initiated immediately after intensive care admission and initial vital sign stabilization. In absence of contraindications (unresolving/decompensated shock, gut ischemia, critical gut stenosis, etc.), the preferred type of enteral nutrition is oral or via a gastric tube. In the acute phase of critical illness, due to gluconeogenesis and muscle breakdown with proteolysis, the need for high protein delivery should be emphasized. After patient condition stabilization, the acute phase with predominant catabolism converts to the anabolic phase and intensive rehabilitation, where high energy demands are the keystone of a positive outcome.

A b s t r a c t Introduction: Ureteral stenosis is one of the most commonly reported urological complications after kidney transplantation.Material and methods: This is a retrospective analysis of the risk factors for ureteral stenosis (type of donor, age of donor, presence of interior polar arteria, unilateral dual transplantation, diabetes mellitus of the recipient and the donor, BK positivity, child recipient, cold ischaemia time, and delayed graft function), as well as the causes and types of treating ureteral stenoses.Results: In the group of 278 patients, the occurrence was 7.2 %. The medial of occurrence of ureteral stenoses was 24.6 months. The independent risk factor for ureteral stenosis in our group was the age of the donor ≥ 70 years [HR 6.5833; 95 % CI 2.2448-19,3070 (P = 0.0006)], BK positivity [HR 13.6667; 95 % CI 6.9127-27.0196 (P<0.0001)], cold ischaemia time > 1080 min [HR 4.0368; 95 % CI 1.7250-9,4465 (P = 0.0013)], and diabetes mellitus in the donor´s history [HR 16.2667; 95 % CI 7.8629-33.6525 (P <0.0001)]. The most frequent type of treating the ureteral stenosis in our group was retroureteroneocystostomy. After surgical treatment, we recorded no recurrence of stenosis.Conclusion: In our analysis, the confirmed independent risk factor was diabetes mellitus of the donor. However, further monitoring and analyses of large groups of patients are necessary. Surgical treatment of ureteral stenosis is safe. However, the most important momentum in surgical treatment of ureteral stenosis still remains the surgeon´s experience in the given type of treatment.

There are many theories that attempt to explain the mechanisms of the effects of inhalation anesthetics -from simpler, pursuing individual effects of anesthetics on the level of the ion channels, to more complex that are looking for uniform global changes in brain activity common to several agents. However, we still don't have satisfactory and adequate conclusions.We examined a sample of 39 patients undergoing thoracic surgery at the Clinic of Thoracic Surgery under general anesthesia (GA) and we registered their electroencephalographic (EEG) signals before and during operation. After induction of GA by intravenous (i.v.), we used inhalation anesthetics to maintain GA. We used sevoflurane (SEV) in 20 patients and desflurane (DES) in 19 patients. Then we obtained the EEG data and processed them through mathematical and statistical analysis, to discover any changes of electrical activity in the brain during thoracic surgery under GA.The era of digital recording EEG and present possibilities of modern computer techniques allow quantitative analysis of obtained data. We performed the analysis with the software LORETA (low resolution brain electromagnetic tomography). It is a relatively new research method, which in a similar way as computed tomography (CT) or magnetic resonance imaging (MRI) displays even deeper brain electrical activity, which is hiddeen for a classical EEG approach.We described the general changes in brain electrical activity of the deeper cortical structures within the traditional frequency bands (d, q, a, b and g) during GA at 5 mm spatial resolution. We have shown that the source of the well-known cortical EEG changes after the effect of used inhalation anesthetics is caused by changes situated in the deeper brain structures, particularly the limbic system. Significant changes occurred in the cingulate gyrus for most of an EEG frequency ranges. When comparing the data of patients anesthetised with SEV and DES we found similar changes within the d and q rhythms and then the global changes of EEG activity followed during GA.

In December 2011, a major revision of GOLD 2011 guidelines was published based on the evidence-based medicine. The goal of GOLD 2011 is to determine the severity of the disease, its impact on the patient's health, and the risk of future events; all of which eventually guide therapy. A combined COPD assessment according to GOLD 2011 considers the patient's level of symptoms, spirometry abnormalities, risk of exacerbation, and the presence of comorbidities. GOLD 2011 stratifies patients into four basic groups labeled A, B, C, and D. The aim of the present study was to assess the importance of updated GOLD guidelines for the diagnosis, treatment, and prevention of COPD. We found that the multicomponent 2011 guidelines offer a significant advantage over the previous mono-component COPD assessment according to GOLD 2006 in terms of disease control and therapy management, with patients enjoying better spirometry values and a higher arterial oxygen content considered the primary outcomes of interest.

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Background: Chronic obstructive pulmonary disease (COPD) is a disease that is characterized by a persistent blockage of airflow from the lungs. It is an under-diagnosed, life-threatening disease which is not fully reversible. COPD is not only global health problem, the disease is also serious economic problem. Objective: The aim of this study was to evaluate the effects of implementation of new guidelines Global Initiative for Chronic Obstructive Lung Disease (GOLD) for diagnosis and treatment of chronic obstructive pulmonary disease (COPD). Design: Consecutive, observational, retrospective, mono-centric study. Methods: Into the study were included all patients admitted with COPD exacerbations to Department of Pneumology and Phtiseology, Jessenius Faculty of Medicine in Martin and University Hospital, separately in year 2008 and year 2013, who have satisfied the inclusion criteria. Those years were chosen specifically from the reason of biennial application of diagnosis and treatment, according to recommended guidelines GOLD 2006 and GOLD 2011, in practice. The study was focused on the basic anthropometric parameters, data of medical history, complications of underlying disease, comorbidities, laboratory parameters, treatment strategy of patients after release from hospital and mortality within one year were evaluated. Results: Patients in group 2013, when were applied guidelines GOLD 2011 had a higher average oxygen saturation and higher pO2 at all stages of the disease, significantly in GOLD D. They had higher values of FEV1 and FVC significantly in GOLD B. There was decrease of overuse of inhalation corticosteroids in group GOLD B from 53.34% to 28.57%. There was a downturn in use of theophylline, significantly in GOLD C. The average number of exacerbations leading to hospitalizations was lower in group 2013 in all stages of the disease. One-year mortality of patients in group 2013 was lower. Conclusions: The implementation and application of guidelines GOLD 2011 in practice is a challenging and complex process, which is in region of University hospital Martin gradually and successfully implemented. The achievement the objectives of the GOLD 2011 not only contributes to the efficiency of prevention and timely diagnosis, but mainly on setting of adequate treatment, improves survival and quality of life of patients with COPD.