Factors associated with gastrointestinal dysmotility in critically ill patients.

Critical illness may disrupt nutritional, protective, immune, and endocrine functions of the gastrointestinal tract, leading to a state of gastrointestinal dysmotility. We aimed to identify factors associated with the occurrence of gastrointestinal dysmotility in critically ill patients. A cross-sectional retrospective study was conducted, using patient files as a source of data. The study included 185 critically ill patients treated in the intensive care unit of the University Clinical Center, Kragujevac, Serbia, from January 1, 2016, to January 1, 2022. Significant risk factors associated with some form of gastrointestinal dysmotility were acute kidney injury (with paralytic ileus, nausea, vomiting, and constipation), recent abdominal surgery (with ileus, nausea, vomiting, and constipation), mechanical ventilation (with ileus, and nausea), age (with ileus and constipation), and use of certain medication such as opioids (with ileus, gastro-esophageal reflux, nausea, vomiting, and constipation), antidepressants (with ileus, nausea, and vomiting), and antidiabetics (with ileus). On the other hand, Charlson comorbidity index had divergent effects, depending on the form of gastrointestinal dysmotility: it increased the risk of gastro-esophageal reflux but protected against ileus, nausea, and vomiting. In clonclusion, recognition of factors associated with gastrointestinal dysmotility should initiate preventative measures and, thus, accelerate the recovery of critically ill.

European association for clinical pharmacology and therapeutics young clinical pharmacologists working group: a cornerstone for the brighter future of clinical pharmacology.

The European Association for Clinical Pharmacology and Therapeutics (EACPT) is a leading society in Europe serving the European and global Clinical Pharmacology and Therapeutics community. Its specific aims include promotion of the utilisation and divulgation of the utility of clinical pharmacology services in health care delivery. EACPT currently has four active working groups (WGs): Education, Regulatory affairs, Clinical research and Young Clinical Pharmacologists (YCP WG). EACPT YCP WG was established in 2015 with the idea of improving education, research, training and networking/mobility opportunities for YCPs across Europe and globe. The main objective of the present manuscript is to provide detailed information on general characteristics, structure, chronogram, objectives, accomplishments and current/future focus areas of the EACPT YCP WG. Consequently, we tend to notably enhance EACPT YCP WG's visibility, increase the number of its members and mobility/networking options and to expand areas of activity even more. Moreover, by this we can also make clinical pharmacology more attractive to early career fellows and colleagues and empower its position alongside other medical specialties.

The influence of the infusion of ephedrine and phenylephrine on the hemodynamic stability after subarachnoid anesthesia in senior adults - a controlled randomized trial.

BACKGROUND: We studied the influence of ephedrine or phenylephrine infusion administered immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. METHODS: A prospective, randomized, double-blind, placebo-controlled study. After a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured blood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA. RESULTS: Seventy patients were included in the final analysis. At the end of measurements, mean arterial pressure (MAP) decreased significantly after SA in comparison to the baseline value in the C group but was maintained in the P and E group, with no significant differences between the groups. CI decreased after SA in the C group, was maintained in the P group, and increased significantly in the E group with significant differences between the C and E group (p = 0.049) also between the P and E (p = 0.01) group at the end of measurements. HR decreased significantly after SA in the C and P group but was maintained in the E group, with significant differences between the P and E group (p = 0.033) at the end of measurements. CONCLUSIONS: Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also maintains HR and increases CI after SA. TRIAL REGISTRATION: ISRCTN registry with registration number ISRCTN44377602, retrospectively registered on 15 June 2017.

Colloid cysts of the third ventricle exhibit various clinical presentation: a review of three cases.

Colloid cysts are benign intracranial tumours usually occurring in the front part of the third ventricle. Clinical presentation may be non-specific and heterogeneous. The problems are frequently associated with development of hydrocephalus, these cysts may cause. We describe three cases of patients with diverse clinical symptoms, who underwent surgery for colloid cysts of the third ventricle. In the first patient, the colloid cyst caused a sudden deterioration of consciousness due to an acute hydrocephalus. The cyst in the second and third patient was discovered accidentally, during the course of epileptic seizures treatment and due to chronic headache with quanti- and qualitative deterioration of consciousness in the setting of chronic hydrocefalus, respectively. Surgery improved health in all three patients.

[Importance of early detection of lung cancers with initial paraneoplastic manifestations].

INTRODUCTION: Lung cancers are mostly detected in the developed clinical stages, with clearly manifested pulmonary, extrapulmonary or metastatic manifestations. In the early disease stages, radiographic and clinical manifestations may be absent or mimicked. OBJECTIVE: The aim of this study was the timely detection of early pulmonary, extrapulmonary and paraneoplastic manifestations of lung cancers in order to apply the most appropriate treatment protocols. METHODS: We examined 230 patients with lung cancer, among them 125 of the working study group with minimal pulmonary and/or initial paraneoplastic symptoms, and 105 patients in the control group with clear tumour manifestations. RESULTS: The symptom analysis revealed a statistically significantly lesser presence of the respiratory symptoms in the working study group (68%) in comparison with the control group of patients (97%) (chi2 = 29.996; p < 0.001). The analysis of radiographic presentations of lung cancer showed that there were significantly more patients with normal findings in the working group (6.4%) than in the control group--1.9% (p > 0.05), and a positive bronchoscopic finding of the centrally localized tumour (mainly right upper lobe) was confirmed in patients of both groups with normal radiographic findings. The number of diagnosed patients in earlier clinical disease stages (I, II, IIIa) with better prognosis in non-small cell lung cancer was significantly higher (chi2 = 19.149; p < 0.001) in the working group (71.1%) in comparison with the control group (38.1%). Small cell lung cancer was more frequently diagnosed in the stage of limited disease in the working (80%) than in the control group (38.1%) (chi2 = 10.039; p < 0.05). With regard to treatment administration, there is a statistically significant difference (chi2 = 4.013; p = 0.0452) in the frequency between the use of chemotherapy and highly significant difference (chi2 = 22.044; p < 0.001) in the frequency of use of surgical treatment in the working group in comparison with the control group--both chemotherapy and surgery treatment were more frequent in the patients of the working group. CONCLUSION: Recognizing the initial pulmonary, extrapulmonary or paraneoplastic manifestations as well as performing diagnostic procedures in due time represent the most important guidelines in early detection and the most efficacious therapeutic choice in lung cancer.

[Association between tobacco smoking and pulmonary tuberculosis].

BACKGROUND/AIM: Numerous studies evaluate the influence of tobacco smoking on the tuberculosis (TB) development, with the results indicating that smoking can be also considered as important risk factor in TB. The aim of this study was to assess the influence of tobacco smoking as the risk factor in the development of TB as well as in its clinical course. METHODS: We analyzed data from the medical records of 192 consecutively hospitalized TB patients (124 males and 68 females) in the Institute of Pulmonary Diseases and Tuberculosis, Clinical Center of Serbia, Belgrade in the period from 2005 to 2007. RESULTS: Among the analyzed TB patients there were more smokers (63.5%) than nonsmokers (36.5%). The majority of the smokers (73.8%) belonged to a middle age group (35-54 years) while the majority of nonsmokers (64.3%) were older than 55 years. Sex ratio among the smokers showed the domination of males (80.3%). There were significantly more males in the smoking group and more females in the nonsmoking group (chi2 = 34.402, p < 0.0001). Most smokers (68.9%) smoked more than 20 cigarettes daily. The average index of pack/years among all of the examinated patients was 32.75 +/- 18.26. Cavitary pulmonary lesions were more frequently verified in the smokers (64.2%) than in the nonsmokers (35.8%). The sputum acid-fast bacillus smear-positive finding was more frequent in the smokers (78%) than in the nonsmokers (22%). The nonsmoking TB patients had more accompanied immunodeficient diseases (34%) than the smoking ones (19%). Body-mass index was lower in the smokers (21.75) than in the nonsmokers (23.80), although this difference did not reach the statistical significance. CONCLUSION: There are more smokers than nonsmokers in TB patients. Smokers more frequently have cavitary forms of TB with sputum acid-fast bacillus smear--positive finding than nonsmokers.