Assessment of mothers' knowledge and evaluation of obstacles to successful breastfeeding

Introduction/Objective: A healthy diet is a basic prerequisite for a healthy child. Numerous studies have proven the importance of breastfeeding, which has many advantages. Breast milk is the best choice of food for a newborn. Healthcare professionals, doctors and nurses, play a key role in shaping a mother's attitude towards breastfeeding, as well as helping her overcome barriers to successful breastfeeding. To examine the level of knowledge mothers have about the importance of proper nutrition and breastfeeding of a newborn and to evaluate any obstacles to successful breastfeeding. Methods: The first part of the research is designed as a cross-sectional study. As a research instrument, a questionnaire was constructed to assess the mothers' level of knowledge about the importance of breastfeeding. In the second part of the research, a telephone survey was conducted after the mothers and babies were discharged from the hospital, and the mothers were asked questions about any obstacles they may have encountered to successful breastfeeding. The study included a sample of 47 women. The study was conducted in the Valjevo General Hospital from June to August 2018. Participation in the study was voluntary and anonymous and the research was approved by the Ethics Committee of the institution. Results: Descriptive statistic methods were used to analyse the results. Respondents ranged in age from 21 to 40, the largest number of women were between 21 and 25 years old (57%), 88% of children received a grade 9 at birth, 10% of the respondents attended parenting school, 78% of the women started breastfeeding the very next day after delivery and most believed that they had been successfully trained to breastfeed in the maternity ward. Seven days after discharge from the hospital, 7% of women did not breastfeed and the most common obstacles to successful breastfeeding were cracked nipples (35%). Conclusion: The results of the research indicate the need for a greater degree of education of future mothers about the importance of breastfeeding and proper breastfeeding techniques. It is necessary to carry out health education work at all levels of health care to minimize obstacles to natural nutrition

Gender differences in concentration of itraconazole and hydroxyitraconazole

Introduction: Itraconazole is an antifungal drug belonging to the triazole group. After oral application, it is rapidly absorbed, but its bioavailability is reduced due to an intensive first-pass through the liver metabolism effect. A large number of metabolites (the most important of which is hydroxyitraconazole) are produced by isoform CYP3A4 of cytochrome P450. The variability of itraconazole pharmacokinetics is the result of numerous factors that have not yet been fully clarified. Our study aimed to investigate the influence of gender on itraconazole and hydroxyitraconazole plasma concentrations in healthy adults after an oral application of a single dose of itraconazole. Methods: Pharmacokinetic analysis was performed after oral administration of itraconazole in a single dose of 100 mg to 22 male and 16 female healthy volunteers. Blood samples were collected before taking the drug and at appropriate time intervals up to 72 hours later. Itraconazole and hydroxyitraconazole concentrations were determined using a validated liquid chromatography method with mass spectrometric detection (LC-MS/MS) and their pharmacokinetic parameters were calculated by using the Kinetica programme, version 5.0: Cmax, Tmax, PIK (0-72), PIK (0-∞), T1/2, and Ke. Results: The median values of both itraconazole and hydroxyitraconazole were lower in women in comparison to men during the whole period of observation. Moreover, median values of Cmax, PIK(0-72) and PIK(0-∞) parameters were also significantly lower in women, concerning both itraconazole (p=0.005, 0.036 and 0.036, respectively) and its metabolite (p=0.004, 0.010 and 0.044, respectively). Elimination parameters - T1/2 and Ke did not differ between genders. Conclusion: Women were less exposed to itraconazole and its active metabolite than men following an oral application of the drug, possibly as a result of lower bioavailability due to a more intense pre-systemic metabolism, as a result of a higher expression and/or activity of the isoform enzyme, which metabolises itraconazole, and which would need to be confirmed by pharmacogenomic analysis.

Civil liability for doctors in the face of a professional (medical) error

Civil liability for healthcare workers and healthcare institutions is one of the most significant problems in Health and Medical Law. The basis of responsibility is always an open question, whether it be medical errors, misinformation or faulty work organization. Aiming to make things clearer for individuals practising medicine, this paper presents the concept of a professional (medical) error, the basis of responsibility for the doctor (medical error, damage to the patient and the cause-and-effect relationship between a medical error and the damage caused) as well as the precise explanation of who has to prove what in possible court proceedings.

Airway inflammation in patients with bronchiectasis

Bronchiectasis is a chronic lung disease characterized by an abnormal dilation of the bronchial lumen caused by weakening or destruction of the muscle or elastic components of the bronchial wall, decreased mucous clearance and frequent infections of the respiratory tract. The golden standard for bronchiectasis diagnosis is high-resolution computed tomography (HRCT) of the chest. Inflammation holds a central role in the development of structural lung changes, as well as airway and lung parenchyma damage. Infection and colonization of the respiratory tract contribute to increased inflammation and further damage to the lung. Upon entry into the respiratory tract, the pathogens activate epithelial cells, macrophages and dendritic cells. Activated inflammatory cells secrete chemical mediators which activate the immune response and thus allow the phagocytosis of pathogens. Early diagnosis, appropriate treatment and interruption of the vicious circle between infection and inflammation in patients suffering from bronchiectasis, prevent the development of structural changes to the airways.

Cardio-cerebral infarction

Introduction/Objective Acute myocardial infarction (AMI) and acute ischemic cerebral infarction (AICI) are both leading causes of death around the world. A simultaneous occurrence of these conditions is called a cardio-cerebral infarction (CCI). We are presenting a case of CCI detected in the prehospital setting as a rarity. Case report: The patient presented is a 78-year-old woman with simultaneous development of AMI and AICI. The diagnosis of a suspected CCI was made in the prehospital setting based on hetero anamnestic data, physical examination findings and ST-segment elevation. At the hospital, additional testing (MDCT of the endocranium, echocardiogram and high troponin levels) confirmed both diagnoses. The patient was treated with fibrinolytic therapy but developed cardiac arrest. After extensive CPR efforts, the patient was pronounced dead. Conclusion: It is necessary to create national guidelines for the diagnosis and treatment of this emergency condition as soon as possible. In the meantime, an individualized approach to each patient is the best policy.

Brugada syndrome detected at the prehospital level

Introduction/Objective Brugada syndrome (BS) is becoming less of a mystery and more of a challenge for early recognition and treatment. We are presenting the case of a patient with Brugada syndrome recognized at the prehospital level. Case report The Emergency Medical Team (EMT) treated a 23-year-old Syrian native, who had fallen ill in a public place. He declared that he had experienced chest pain, 7/10 in strength, and weakness on the left side of his body followed by a short-term collapse some 20 minutes earlier. After that, he felt weak, languid, very tired and had neck pain. As declared by witnesses, he did not lose consciousness, but was confused, pale, covered with sweat and was breathing rapidly. All this happened after a prolonged quick-paced walk in high air humidity conditions. He declared that he hadn't had similar episodes before, nor had he had significant injuries, allergies or chronic diseases. There was no sudden cardiac death history in his family. Upon examination, he was conscious, afebrile, eupnoeic (18 breaths per minute) with normal heart frequency (70 per minute), blood pressure of 120/90 mmHg and blood oxygen saturation level of 100%. His heart and breath sounds were normal. All other physical examination findings were normal as well. ECG: sinus rhythm, 70 beats per minute, saddleback ST-segment elevation > 1mm in V2. An IV line was inserted and an ECG monitor placed. He was transported to the hospital with the diagnosis of having collapsed and a suspected Brugada syndrome. After short observation and a repeated ECG recording, the Brugada syndrome type II diagnosis was confirmed. Conclusion The Emergency Medical Team doctor must recognize the ECG pattern of this disease, apply necessary CPR measures including early defibrillation if needed, and closely monitor the ECG and vital signs of the patient during transport.

Lung abscess as a complication of COVID-19

Introduction/Objective: A lung abscess is a localized purulent inflammation of lung tissue with necrosis and colliquation. We are presenting a rare case of lung abscess formation as a result of the COVID-19 viral infection. Case report: An 81-year-old male patient with typical complaints (fever, malaise, fatigue) was examined at a designated medical centre for COVID patients. A positive PCR test and radiology findings confirmed a COVID-19 infection. Medication was prescribed according to protocol and he was sent home. During the night, 36 hours after the onset of the first symptoms, the patient developed breathing difficulties and a persistent, irritating dry cough. He was admitted to the Covid Hospital Karaburma, where he received treatment for 35 days. On the 22nd day after being released, the patient was examined at the Emergency Medical Centre, Clinical Centre of Serbia, complaining of dyspnoea, occasional hemoptysis and fatigue. The working diagnosis was pulmonary embolism. A multislice CT scan was ordered only to reveal a pulmonary abscess at the base of the left lung. Conclusion: A lung abscess is a rare, but possible complication of a COVID-19 infection. Therefore, patients should be regularly monitored for an extended period of time following hospitalization.

Cardiopulmonary resuscitation in the prone position

Cardiopulmonary resuscitation (CPR) is a series of life-saving procedures aimed at restoring and maintaining the functions of breathing and circulation in patients suffering from cardio-respiratory arrest. Old and new CPR guidelines assume that the patient is lying on the back, on a hard and stable surface. The prone position where the patient is lying on the stomach is often used in the operating room to enable an easier approach to the operative field and in intensive care units (ICU) to enable better oxygenation for patients in advanced stages of hypoxic respiratory insufficiency. During the COVID-19 pandemic, patients suffering from the infection are often treated in the prone position. Should cardiac arrest occur, it is necessary to initiate high-quality chest compressions and early defibrillation as soon as possible for the patient to have the best chance of survival. Current guidelines stipulate that CPR should be initiated immediately, even in the prone position, and kept up until conditions are met for the patient to be turned over onto the back. It is recommended to place hands on the patient's back at the level of the T7-T10 vertebrae and perform chest compressions with the usual strength and velocity (5-6 cm deep, 2 compressions per second). For defibrillation, self-adhesive disposable electrodes should be placed in an anterior-posterior or a bi-axillary position. Sternal counterpressure could increase the efficacy of chest compressions. Educating health workers to perform this CPR technique and using it in selected patients can increase survival.

Mini-open carpal tunnel release technique

Introduction/Aim: Carpal tunnel syndrome (CST) is the most common cause of upper extremity compressive neuropathy. Until the introduction of endoscopy, the dominant surgical method was classic open surgery. The objective of the paper is to examine the efficacy, safety and economic value of the mini-open carpal tunnel release technique using a longitudinal 2 cm long incision in the carpal region. Methods: The diagnosis was made based on clinical examination, followed by an ENMG. The study includes only patients with idiopathic CTS, while those who have developed CTS as a result of secondary causes have been excluded from the study. All patients were operated on under local anaesthesia, WALANT, without the use of a tourniquet. A longitudinal incision 2 cm long is made in the line of the radial edge of the ring finger, 2-3 cm distal to the wrist flexion crease, immediately proximal of the Caplan cardinal line and ulnar to the thenar crease. Upon cutting through the skin and subcutaneous soft tissue, the superficial fascia is identified and then cut with the same scalpel in the same direction and the same length. The transversal ligament is then identified and carefully incised with a scalpel enough to allow further decompression with the use of scissors. Using standard surgical scissors for the hand, the ligament is cut proximally to the forearm fascia and then distally until a faint crackling sound is heard, which means that the ligament had been completely cut. This must be checked by inserting the Freer elevator proximally and distally to the edge of the ligament. Now it is possible to identify the nerve and accompanying hand flexor tendons. Sutures are placed only on the skin and a roll of gauze is fixed to the wound with an elastic bandage to provide compression. The first check-up is on the very next day and the patient is advised to start doing hand exercises. The sutures are removed 10-14 days after surgery. Results: From January 2018 to December 2019, 35 carpal tunnel decompressions were performed on 30 patients using the mini-open decompression technique and standard surgical scissors. The surgery was performed on 22 patients in the operating room and 8 patients in the infirmary. There were no intraoperative complications. All patients reported no night pain from the very first day after surgery. Pillar pain, incision pain and hand weakness were progressively becoming less pronounced during the next 12 weeks. At the final check-up, only one patient still had pronounced symptoms that required a reintervention. The rest of the patients had completely recovered. Even though the endoscopic procedure for carpal tunnel decompression is constantly evolving, the classic open method and newly developed mini-open carpal tunnel release technique remain the treatments of choice. Conclusion: Our research shows that the mini-open carpal tunnel release technique is a quick, efficient, safe and cheap surgical technique for treating carpal tunnel compressive neuropathy.

SARS-COV-2 transmission among family members

Introduction/Objective Severe acute respiratory distress syndrome caused by coronavirus 2 (SARS-COV-2) is a new respiratory disease -COVID-19. A virus from the Coronaviridae family, highly contagious and virulent took over the world in a very short time causing the 2019/2020 pandemic. We are presenting the case of COVID-19 transmission among family members, patients of various ages, sex, clinical presentation and findings, who have been infected in different ways. Case reports Three patients are described, all with different coronavirus-specific symptomatology. Symptoms ranged from fatigue and loss of appetite with no other, more prominent symptoms in the youngest patient, to fever, high temperature, diarrhoea, muscle ache and chest pain during inspiration in the oldest patient. The third patient's dominant symptoms were dry, non-productive cough, lack of oxygen, shortness of breath and perspiration on exertion, headache and normal temperature, with radiographically confirmed bilateral pneumonia. Laboratory findings (leukopenia, lymphocytopenia with elevated C-reactive protein levels, high erythrocyte sedimentation rate and lactate dehydrogenase levels) were consistent with a viral infection, highly suspicious of SARS-COV-2, which was confirmed with a real-time RT-PCR test in all three patients. After being hospitalized in the Clinical Hospital Center "Zemun" Department of Pulmonology and treated with symptomatic, antiviral and antibiotic therapy, the disease regressed and the RT-PCR tests became negative. Conclusion SARS-COV-2 is a very aggressive and potent cause of the coronavirus disease. The presented cases confirm the possibility of quick transmission within a family through direct and indirect contact, as well as the diversity of symptoms, laboratory and clinical findings. Our clinical examples are similar in symptomatology and available results to cases from other parts of the world hit with the pandemic.