Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26
Filtrar
1.
Antibiotics (Basel) ; 12(1)2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36671312

RESUMO

The 2019 coronavirus pandemic (COVID-19) has affected clinical practice and, consequently, drug prescribing in dental practice. We investigated how the pandemic affected the prescribing behavior of dentists in Croatia. Data on prescribing practices for this study were provided by the Croatian Health Insurance Institute. The analysis included the number of prescriptions, costs, and the number of packages prescribed. The World Health Organization's defined daily dose per 1000 inhabitants (DID) per day was used as an objective utilization comparison. During the first pandemic year, prescribing practice changed the most. Wide-spectrum antibiotics, analgesics, and antiseptics showed the highest trend in change. A statistically significant change in prescribing practices during the pandemic period was noted for amoxicillin with clavulanic acid, ibuprofen, and ketoprofen which showed an increase in trend, while cephalexin and diclofenac showed a statistically significant decrease. The highest increase in trend was recorded for azithromycin, at +39.3%. The COVID-19 pandemic has been associated with a marked increase in medication utilization, especially in the first year of the pandemic. The increase in wide-spectrum antibiotic classes needs to be addressed and regulated so that patients accept that antibiotics are not a substitute for dental treatment and dentists always start treatment with narrow-spectrum antibiotics regardless of specific times, as is the case with the pandemic.

2.
J Clin Exp Dent ; 13(7): e648-e652, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34306527

RESUMO

BACKGROUND: The objective of this study was to assess the attitude, practice, and knowledge of Croatian dentists regarding infective endocarditis (IE) prophylaxis. MATERIAL AND METHODS: A cross-sectional, self-reporting questionnaire survey was conducted with the participation of 348 Croatian dentists. The questionnaire was designed to collect information on participants' work experience, place of work, their attitudes related to the treatment of IE-risk patients, knowledge and adherence to IE antibiotic prophylaxis guidelines. RESULTS: Knowledge and adherence to the current guidelines decreased with the higher years of experience. Compliance with the current guidelines varied, mostly because of respondents' insecurity regarding which guidelines to follow. AHA guidelines have been most frequently the first choice (25% participants). Surprisingly, 23% of dentists didn't follow any of the official guidelines. The majority of participants (68%) have declared a lack of preparedness or willingness to treat the patients at risk of IE. Dentists with specialty or working at university/hospital have shown a higher level of knowledge and preparedness to treat IE-risk patients. CONCLUSIONS: The lack of knowledge of guidelines and consequent inconsistencies in IE antibiotic prophylaxis in Croatian dental practice indicates the need for urgent improvement. Key words:Antibiotic prophylaxis, dentistry, infective endocarditis.

3.
Int Dent J ; 71(6): 484-490, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33648770

RESUMO

OBJECTIVES: The objective of this study was to analyse the pattern of medication prescribing among dental practitioners in the Republic of Croatia and to compare it with general medical practice patterns at the national level. METHODS: Data on drug prescriptions were obtained from the Croatian Health Insurance Fund. The number of dentist prescriptions, the cost of medicine denominated in the national currency (Croatian Kuna [HRK]), and the number of packages and days prescribed have been included in the analysis. RESULTS: Results indicate that there was an increase in medication prescribing(+5.7%) by dentists, with antimicrobials comprising the majority, whereas national medical antimicrobial prescribing had slightly decreased. Antibiotics accounted for 80% of all dentists' prescriptions, with penicillins being the most commonly prescribed. In particular, amoxicillin with clavulanic acid accounted for 56.4% of all antibiotics prescribed. Such broad-spectrum antibiotics were prescribed more frequently than those of narrow-spectrum. Antibiotics were followed by nonsteroidal anti-inflammatory drugs, with prescribing frequency for ibuprofen increasing by 75%. CONCLUSION: Current trends show an increase in the overall prescription rate for all medications prescribed by dentists. The largest increase was observed for the broad-spectrum amoxicillin with clavulanic acid, and ibuprofen. As the apparent widespread use of broad-spectrum antibiotics by dentists in Croatia is in contrast to national and international recommendations for antibiotic stewardship, there is a need for further prospective investigation and possible provider education and guidelines.


Assuntos
Antibacterianos/administração & dosagem , Odontólogos , Padrões de Prática Odontológica , Amoxicilina , Croácia , Prescrições de Medicamentos/estatística & dados numéricos , Humanos , Papel Profissional
4.
Acta Clin Croat ; 59(3): 543-548, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34177067

RESUMO

Although subacute sclerosing panencephalitis is almost exclusively a childhood disease, it can occur in adults as well. We present an atypical case of adult-onset subacute sclerosing panencephalitis. The disease was characterized by prolonged insidious course followed by accelerated and aggressive phase, atypical EEG findings, and absence of myoclonic jerks. The diagnostic and treatment-related pitfalls are discussed.


Assuntos
Panencefalite Esclerosante Subaguda , Adulto , Criança , Eletroencefalografia , Humanos
5.
Eur J Clin Microbiol Infect Dis ; 39(4): 637-645, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31786693

RESUMO

Antibiotic prophylaxis (AP) of infective endocarditis (IE) in dental practice is a controversial topic. We evaluated the characteristics of the odontogenic IE and assessed the practice and sources of information pertaining to the topic utilized by the Croatian dentists. We conducted a retrospective review of consecutive medical charts of adult patients with IE, admitted to the University Hospital for Infectious Diseases in Zagreb, Croatia, between January 2007 and December 2017. In addition, a cross-sectional, self-reporting questionnaire survey was conducted with participation of 348 Croatian dentists. Of the 811 admissions for suspected IE (40.3% of all Croatian and 92.1% of all Zagreb hospitals), 386 patients were confirmed as definite IE: 68 with odontogenic IE and 318 with IE of other origin. Their first hospital admissions were analyzed. Definite odontogenic IE was defined as a positive echocardiographic result in conjunction with two separate positive blood cultures showing exclusive oral cavity pathogen or Streptococcus viridans associated with current or recent (< 1 month) dental, periodontal, or oral cavity infection. The annual number of new odontogenic IE patients appeared constant over time. In 91.2% of the cases, odontogenic IE was not preceded by a dental procedure; poor oral health was found in 51.5% of patients, and 47.1% had no cardiac condition that increases the IE risk. In-hospital mortality was 5.1% with conservative treatment and 4.5% with cardiac surgery and was much lower for odontogenic IE than in non-odontogenic IE (14.6% and 34.4%, respectively). An increasing number of admissions for non-odontogenic IE were observed in parallel with an increasing number of staphylococcal IE. Surveyed dentists (500 invited, 69.6% responded) were aware of the AP recommendations, but were largely reluctant to treat patients at risk. In people with poor oral health, AP should be considered regardless of cardiac risk factors. Improvement of oral health should be the cornerstone of odontogenic IE prevention.


Assuntos
Antibioticoprofilaxia , Assistência Odontológica/efeitos adversos , Endocardite/epidemiologia , Endocardite/etiologia , Idoso , Croácia/epidemiologia , Estudos Transversais , Endocardite/prevenção & controle , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Odontogênese , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/etiologia , Inquéritos e Questionários , Estreptococos Viridans/isolamento & purificação , Estreptococos Viridans/patogenicidade
7.
Acta Clin Croat ; 53(2): 252-5, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25163244

RESUMO

Sever's disease is juvenile osteochondrosis of calcaneus, manifested with posterior heel pain and mild swelling, usually in young athletes, caused by repetitive microtrauma. The standard diagnostic procedures include radiographs and ultrasound examination. It is a self-limiting condition, usually treated conservatively. We present a case of Sever's disease complicated with calcaneal osteomyelitis. A 9-year-old boy with a several month history of left heel pain was admitted to our institution for further clinical evaluation and therapy. Bilateral Sever's disease was clinically diagnosed, confirmed by radiographs and ultrasound examination. Magnetic resonance imaging (MRI) showed osteolytic zone in the posterior left calcaneus with peripheral enhancement after contrast administration and surrounding bone and subcutaneous edema, suggestive of osteomyelitis. After six weeks of parenteral antibiotic treatment, the patient's condition improved. Follow up MRI performed 3 months later showed significant regression of osteolytic lesion and replacement with granulation tissue surrounded with new bone formation. To our knowledge and literature search, this is a previously unreported complication of Sever's disease. MRI should be done in all atypical cases of Sever's disease to rule out any other possible disorders including osteomyelitis.


Assuntos
Calcâneo , Osteocondrose/complicações , Osteocondrose/diagnóstico , Osteomielite/complicações , Osteomielite/diagnóstico , Criança , Humanos , Imageamento por Ressonância Magnética , Masculino , Osteocondrose/terapia , Osteomielite/terapia
8.
Clin Neurol Neurosurg ; 123: 181-6, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24981517

RESUMO

OBJECTIVE: Despite advances in antibiotic therapy and critical care, community-acquired bacterial meningitis (CABM) continues to have poor outcome in a significant portion of patients. This study was designed to assess the efficacy of therapeutic hypothermia (TH) in the treatment of CABM. MATERIAL AND METHODS: In a period from January 2009 to January 2013, 41 enrolled patients with CABM were treated with TH. Their outcome was compared to 90 patients in the historical control group that were recruited from the existing database and included patients in a period between 1994 and 2008 with Glasgow coma scale score (GCS) ≤9 and respiratory failure. TH was indicated in patients with GCS ≤9, respiratory failure, and breath holding index ≤0.835 (measured with transcranial Doppler). If the acoustic window was absent, GCS ≤9 plus optic nerve sheath diameter of ≥6mm plus respiratory failure were indications for TH. RESULTS: Outcome variables were mortality and neurologic recovery measured with the Glasgow outcome scale (GOS). The incidence of hospital mortality (19.5% vs 48.9%, p=0.002) and adverse neurological outcome (GOS 1-3) (43.9% vs 65.6%, p=0.023) were significantly lower in patients treated with TH. Multivariate analysis confirmed the positive effect of TH on hospital mortality (OR=0.059, 95% CI 0.017-0.211) and risk of adverse neurological outcome (OR=0.209, 95% CI 0.082-0.534) after an adjustment for other risk factors of unfavorable patients' outcome. CONCLUSIONS: The new therapeutic concept based on hypothermia significantly improves the outcome in adult patients with severe CABM.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Hipotermia Induzida , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Estudo Historicamente Controlado , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Resultado do Tratamento , Adulto Jovem
9.
J Glob Infect Dis ; 6(2): 73-5, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24926167

RESUMO

Pneumococcal meningitis represents the most severe community-acquired bacterial meningitis. The disease is frequently associated with various complications. We present a case of pneumococcal meningitis in an immunocompetent adult patient treated with hypothermia. The disease course was complicated with severe myelitis and consequent paraplegia which is an extremely rare complication of pneumococcal disease.

11.
Diagn Microbiol Infect Dis ; 73(3): 271-2, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22504065

RESUMO

We present a case of chronic meningitis due to the mold Aureobasidium proteae. Clinical features, the disease course, as well as the diagnostic methods and optimal treatment options are discussed. This case confirms the neuroinvasiveness of A. proteae and introduces it as a new human pathogen.


Assuntos
Ascomicetos/isolamento & purificação , Meningite Fúngica/diagnóstico , Meningite Fúngica/patologia , Antifúngicos/administração & dosagem , Doença Crônica , Humanos , Masculino , Meningite Fúngica/tratamento farmacológico , Meningite Fúngica/microbiologia , Pessoa de Meia-Idade
12.
J Neurol ; 259(2): 225-36, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21706150

RESUMO

UNLABELLED: The aim of the study was to assess adjunctive intravenous dexamethasone in adult community-acquired bacterial meningitis (BM) in daily practice. Analysis of consecutive patients (1990-2009) with acute community-acquired bacterial meningitis in a single centre in Zagreb, Croatia, N = 304. Adjusted relative risks [RR, dexamethasone vs. no dexamethasone (control)] of Glasgow Outcome Scale (GOS) = 1 (death) and GOS = 5 (full recovery) at discharge/end of specific treatment were estimated considering demographics; co-morbidity; BM pathogenesis and on-admission characteristics, and cerebrospinal fluid (CSF) inflammation markers; causative agent and antibiotic use. Two hundred forty (79%) patients had proven BM (43.1% Streptococcus pneumoniae, any other agent ≤ 8.2%). No independent effects of dexamethasone on GOS = 1 or GOS = 5 were observed in the entire cohort (dexamethasone n = 119, control n = 185; RR = 1.06, 95% CI 0.77-1.45 and RR = 0.99, CI 0.83-1.20, respectively), microbiologically proven disease (dexamethasone n = 104, control n = 136; RR = 0.97, CI 0.69-1.38 and RR = 1.03, CI 0.82-1.28), pneumococcal disease (dexamethasone n = 71, control n = 60; RR = 0.95, CI 0.53-1.70 and RR = 0.82, CI 0.57-1.18), and also in other BM, subgroups based on consciousness disturbance, CSF markers, prior use of antibiotics and timing of appropriate antibiotic treatment. CSF markers did not predict the outcomes. CONCLUSIONS: Our experience does not substantiate the reported benefits of adjunctive dexamethasone in adult BM. Socio-economic and methodological factors do not seem to explain this discrepancy. Empirical use of dexamethasone in this setting appears controversial.


Assuntos
Anti-Inflamatórios/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Dexametasona/uso terapêutico , Meningites Bacterianas/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos , Quimioterapia Adjuvante , Infecções Comunitárias Adquiridas/líquido cefalorraquidiano , Feminino , Escala de Resultado de Glasgow , Humanos , Inflamação/líquido cefalorraquidiano , Inflamação/tratamento farmacológico , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/efeitos dos fármacos , Adulto Jovem
13.
Neurol Sci ; 33(1): 155-8, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21556865

RESUMO

We present for the first time a case of acute encephalopathy in an adult patient induced by Campylobacter jejuni enteritis. Possible pathogenic mechanisms and importance of neuropsychological testing in the assessment of infection-related encephalopathy are discussed.


Assuntos
Infecções por Campylobacter/complicações , Campylobacter jejuni/isolamento & purificação , Encefalite/etiologia , Enterite/complicações , Feminino , Humanos , Adulto Jovem
14.
Neurocrit Care ; 15(1): 151-5, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21246306

RESUMO

BACKGROUND: Despite the advances in critical care, severe viral meningoencephalitis continues to impose high rates of morbidity and mortality. Consequently, new treatment strategies are needed and we present therapeutic hypothermia (TH) as one of the possible efficacious treatment tools. METHODS: We present the case series in an adult intensive care unit of a tertiary care hospital. Eleven patients suffering from severe viral meningoencephalitis were treated with hypothermia. The major indication for TH was severely impaired consciousness associated with carbon dioxide reactivity loss assessed by Transcranial Doppler. Besides from the established treatment, all the patients underwent TH. Mild hypothermia (rectal temperature of 32-34°C) was maintained with continuous veno-venous hemofiltration. RESULTS: Median Glasgow coma scale score in our patients at admission was 8 (3-10) and median Acute Physiology and Chronic Health Evaluation score was 24 (12-32). The overall mortality rate was 9% (1/11). Among survivors, the outcome was favorable in five patients [Glasgow Outcome Scale score (GOS) 4-5]. Remaining five patients had severe residual neurological deficit (GOS 3). Median GCS at discharge was 15 (8-15). With respect to disease severity, the outcome in presented patients was generally satisfactory. CONCLUSIONS: Our results suggest that use of mild hypothermia in selected adult patients with viral meningoencephalitis could be a promising treatment tool.


Assuntos
Encefalite Viral/terapia , Hipotermia Induzida , Meningoencefalite/terapia , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Encefalite Viral/diagnóstico , Encefalite Viral/mortalidade , Feminino , Humanos , Masculino , Meningoencefalite/diagnóstico , Meningoencefalite/mortalidade , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
15.
J Infect ; 62(2): 172-7, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20950646

RESUMO

We present the case series of adult community-acquired bacterial meningitis treated with hypothermia. The major criteria for therapeutic hypothermia (TH) was impaired carbon dioxide reactivity (CO(2)R) assessed by Transcranial Doppler (TCD). In patients without temporal acoustic window, minor criteria (optic nerve sheath diameter ≥ 6.0 mm plus GCS ≤ 8) were required. According to our, although limited experience, the use of mild hypothermia in selected patients with community-acquired bacterial meningitis accompanied with appropriate monitoring could be a promising treatment tool.


Assuntos
Hipotermia Induzida , Meningites Bacterianas/terapia , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono/análise , Circulação Cerebrovascular , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia Doppler Transcraniana
16.
Neurol Sci ; 32(1): 139-42, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20526642

RESUMO

We present a case of pneumococcal meningitis complicated by leukoencephalopathy. Possible pathogenic mechanisms, a diagnostic pitfall, and optimal treatment options are discussed.


Assuntos
Leucoencefalopatias/etiologia , Meningite Pneumocócica/complicações , Idoso , Feminino , Humanos , Avaliação de Estado de Karnofsky , Leucoencefalopatias/diagnóstico , Imageamento por Ressonância Magnética/métodos
17.
Acta Clin Croat ; 48(2): 179-82, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19928419

RESUMO

We report two cases of severe late-onset nosocomial pneumonia caused by Chlamydophila pneumaniae. The clinical course of the disease in these patients suggests that nosocomial pneumonia caused by this agent can lead to profound respiratory insufficiency and acute respiratory distress syndrome, particularly in patients with significant comorbidities and during the postoperative period. Intravenous azithromycin treatment was used to cure pneumonia in both of our patients.


Assuntos
Infecções por Chlamydophila , Chlamydophila pneumoniae , Pneumonia Bacteriana , Idoso , Infecções por Chlamydophila/diagnóstico , Infecções por Chlamydophila/terapia , Humanos , Masculino , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/terapia
18.
Scand J Infect Dis ; 41(10): 708-13, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19685379

RESUMO

The objective of this open cohort study was to assess the association between neurological complications in patients with definite native-valve infective endocarditis (IE) and cerebral microembolism (MES). MES detection was performed with 1-h, bilateral middle cerebral arteries (MCA) insonation using a transcranial Doppler ultrasound (TCD) machine. Thirty patients with definite native-valve IE were stratified into 2 groups based upon the presence of MES. The most striking difference between the 2 groups of patients was the incidence of clinically evident neurological complications. Neurological complications of IE occurred in 10 (83.3%) patients with positive MES and in 6 (33.3%) MES-negative patients (p=0.021). Ischaemic stroke was the most common complication, occurring in 11 of 16 patients, followed by meningitis in 4 patients and cerebritis in 1 patient. There was a trend towards greater in-hospital mortality in patients with recorded MES than in the MES-negative, although this was not statistically significant (33.3% vs 16.6%; p=0.392). Our results reveal a significant association between MES and neurological complications in patients with native-valve IE. TCD is a promising tool in predicting individual patient risk for neurological complications of IE.


Assuntos
Endocardite/complicações , Embolia Intracraniana/complicações , Doenças do Sistema Nervoso/etiologia , Adulto , Idoso , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Distribuição de Qui-Quadrado , Estudos de Coortes , Endocardite/diagnóstico por imagem , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Masculino , Meningite/diagnóstico por imagem , Meningite/etiologia , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico por imagem , Estudos Prospectivos , Ultrassonografia Doppler Transcraniana
19.
Neurol Sci ; 30(1): 51-4, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19145403
20.
Neurocrit Care ; 10(1): 70-2, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-18528786

RESUMO

INTRODUCTION: Numerous systemic infections are capable of inducing myositis and rhabdomyolysis. Clinical course of the disease is in the great majority of patients benign and without development of renal dysfunction. However, serious consequences are possible if acute renal failure (ARF) occurs, especially in critically ill patients. METHODS: Patient with Listeria monocytogenes meningitis associated with rhabdomyolysis and acute non-oliguric ARF is presented. RESULTS: Sixty-nine-year-old white male was admitted to our intensive care unit because of listerial meningitis. The course of the disease was complicated with rhabdomyolysis and non-oliguric ARF. After antimicrobial treatment with parenteral trimethoprim-sulfamethoxazole and 4 days of continuous veno-venous hemodiafiltration (CVVHDF) the patient recovered. CONCLUSION: We report a case of listerial meningitis complicated with non-oliguric ARF. Rhabdomyolysis should be considered in all patients with infection and increased CK, especially if consciousness is impaired is altered. Furthermore, despite the normal diuresis ARF could be present and result in adverse consequences. We infer that timely diagnosis and treatment should improve the outcome of infection-induced rhabdomyolysis and could prevent a proportion of associated ARF.


Assuntos
Injúria Renal Aguda/microbiologia , Meningite por Listeria/complicações , Meningite por Listeria/diagnóstico , Rabdomiólise/microbiologia , Idoso , Humanos , Masculino , Meningite por Listeria/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...