Analysis of the key issues in the organization of emergency care for stroke and heart attack patients in Bjelovar-Bilogora County.

Emergency care for patients with acute ischemic stroke and acute myocardial infarction according to the principles of evidence-based medicine is a challenge for the healthcare system, as it requires a multidisciplinary approach and good cooperation of all the subjects involved. The time elapsed from symptom onset to patient admission to the hospital, and the period from admission to the hospital to the beginning of therapy play an essential role in the thrombolytic treatment of stroke. For the patient, effective functioning of the system can mean the difference between preserved functional independence and disability. In recent years in Bjelovar-Bilogora County, there has been some development in emergency care of patients with acute heart attack by applying thrombolytic therapy and organizing transfer of indicated cases to the nearest clinical department for invasive cardiologic therapy. In case of acute ischemic stroke, thrombolysis has so far remained the only method of causal treatment. Results of a retrospective study conducted in 2010 in Bjelovar General Hospital on 169 patients with the established time of ischemic stroke symptom onset showed that only 39.64% of patients reached the hospital for treatment within the target time window. The results indicated the need for continuous efforts in preventing cardiovascular and cerebrovascular disease, as well as for education of citizens and healthcare professionals in recognizing the early symptoms of stroke and understanding them as an emergency condition. The present situation calls for permanent education of health workers in first line contact, an increase in the number of neurologists and cardiologists, as well as the introduction of stroke units on the model of coronary units, with constant presence of specialists. The radiology and laboratory services need adjustment to enable performing diagnostic procedures within the given time limit. At the national level, a network of stroke units should be organized, which would eliminate distance to county hospitals as a limiting factor in effective treatment.

[Treatment of renal anemia with iron in hemodialysis patients in General Hospital Bjelovar]. / Lijecenje anemije kronicne bubrezne bolesti zeljezom u bolesnika na kronicnom programu hemodijalize.

Renal anemia is caused by a lack of erythropoietin and iron, and is associated with increased morbidity and mortality in patients with chronic kidney disease. Iron deficiency is more common than previously thought. Diagnosis of absolute and relative iron deficiency is difficult because of the lack of an ideal diagnostic method. Adequate supplementation of iron in patients with renal anemia at a certain percentage of patients corrects anemia, while the other reduces the required doses of erythropoesis stimulating agents (ESAs), which can reduce treatment costs. In Department of Dialysis of General Hospital Bjelovar we carried out a retrospective study about treating renal anemia with iron during 36 months in 67 patients on chronic hemodialysis program in a period from 2007. to 2010. Our goal was to see if we adequately treat renal anemia with iron and to show the connection between the level of hemoglobin (Hb), ferritin and transferrin saturation (TSAT). The average value of ferritin in the 36 months follow-up was 196.8mcg/l, TSAT 24.16%, 107.8 g Hb/l. We conclude that the elevation of ferritin and TSAT correlates with the increase of Hb values in patients with renal anemia. Ferritin and TSAT values in our center are above the minimum criteria recommended by guidelines, but not within the target values for the treated population.

[Treatment of renal anemia in hemodialysis patients in General Hospital Bjelovar from 2007 to 2010]. / Lijecenje anemije kronicne bubrezne bolesti u bolesnika na programu kronicne dijalize u OB Bjelovar u razdoblju od 2007. do 2010. godine.

Renal anemia is complication of chronic kidney disease. It is caused by crythropoietin deficency and is associated with adverse outcomes in CKD patients. Renal anemia should be treated with erythropoesis-stimulating agents (ESAs), supplementary iron, adequate dialysis, and if necessary with red blood cells transfusions. The main problem of treatment is how to determine target hemoglobin value and keep it within the constant range. Current guidelines recommend target hemoglobin level 110 - 120 g/l, but optimal value need to be adjusted for every patient individualy keeping in mind primary kidney disease, age, gender and comorbidities. In Department of Dialysis of General Hospital Bjelovar we carried out a retrospective study about treating renal anemia in 67 patients on chronic hemodialysis program during 36 months in a period from 2007. til 2010. We monitored hemoglobin, feritin, saturation of transferin (TSAT), dose of LSE, number of change in dosage and number of transfusion. Mean hemoglobin level was 107.8 g/l, feritin level 196.8 mcg/l, TSAT 24.16%, weekly dose of ESAs 5951.9 IU. in 53.7% patiens dose was changed 11 - 20 times during that period, and 34% of patiens was treated with at least 1 dose of transfusion of red blood cells. We conclude that better iron supplementation and moderately higher doses of FSAs correlate with higher hemoglobin value, and hemoglobin variations is still big problem in renal anemia treatment.