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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

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What is new in the 2016 European Society of Cardiology atrial fibrillation guidelines?


The present review seeks to highlight important changes in the recently published atrial fibrillation (AF) guidelines of the European Society of Cardiology (ESC) in comparison to previous recommendations, which are summarized as follows: (1)

Key words: atrial fibrillation, anticoagulation, cardioversion, multidisciplinary heart team

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The effect of ambient noise in the NICU on cerebral oxygenation in preterm neonates on high flow oxygen therapy


In this early pilot study, we sought to determine if the alteration in these physiologic effects in premature infants in response to ambient noise in the NICU could be assessed evaluating cerebral blood saturation. Three premature infants, on high flow nasal cannula oxygen support (HFNC), at less than 34 weeks of gestation were included in the study. Three variables were used to evaluate sound levels due to AAP and EPA guidelines; Leq,1h, L10,1h and Lmax,1min.

All of the patients studied were found to be exposed to statistically significant noise levels (above recommendation) throughout all of the time periods measured. Noise levels were found to be similarly elevated during the 1 am and 3 pm time periods as well, though not as much as compared to the 7 am measure. A statistically significant difference was found within every patient’s rSO2 levels in both hemispheres, but also in the absolute differences of rSO2. Positive significant statistical correlations were found between the average rSO2 and Leq,1h (ρ=0.14), Lmax,1min (ρ=0.18), L10,1h (ρ=0.15). Significant negative correlations were found between the absolute difference levels and Lmax,1min (ρ=-0.3), and L10,1h (ρ=-0.18)

This data highlights the need for further study as to the potential impact of noise on the cerebral physiology of premature infants. Further research is needed to assess the potential long-term side effects of environmental noise on the premature infant’s brain.

Key words: noise, infant, new-born, neonatology, noise measurement

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The treatment of posthaemorrhagic hydrocephalus


The paper presents the authors’ analysis of their own treatments of intraventricular bleeding and posthaemorrhagic hydrocephalus in premature infants in the period from December 2009 to January 2016.

Infants who are born before the 37th week of pregnancy are at a higher risk for perinatal complications. Intraventricular bleeding is a common complication in premature infants with low birth weight who are treated in units for intensive care and therapy.

Infants who are most at risk are those with low birth weight (under 1,500 g) and born before the 30th week of gestation. According to data from literature, 30 – 50% of infants born before the 30th week suffer intraventricular haemorrhage. More severe haemorrhage results in posthaemorrhagic hydrocephalus.

High morbidity and mortality require an early recognition, treatment and regular follow-up of these infants.

Key words: premature infant, intraventricular bleeding, hydrocephalus, treatment

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Urine high sensitive Troponin I measuring in patients with hypertension


High sensitive troponin I (hsTnI) is one of the markers of cardiac damage. Its values increase two to three hours after a heart attack and remain elevated for days. Recent studies have shown that kidneys are the main organ of elimination of troponin from blood. Our previous studies have shown that troponin I is removed and concentrated in the first morning urine.

Increased blood pressure is one of the most common comorbidities today. By measuring blood pressure, we can see the current value of the pressure, but we do not know what the values are during the rest of the day. The aim of our research was to determine if there is a difference in the concentration of troponin I in urine among patients suffering from hypertension and among healthy individuals.

The study involved 20 participants divided into two groups. In the first group were healthy individuals, while in the second group were individuals with hypertension. The first morning urine was sampled and the hsTnI was measured using a high-sensitivity test on the Immuno-enzymatic analyser Abbott Architect i1000SR.

Within the normotensive group, the mean value of hsTnI in the first morning urine was 14.95 pg/mL, while in the group of participants with elevated blood pressure, the mean value of hsTnI in the first morning urine was 26.59 pg/mL. The difference between these two groups was statistically significant with p=0.0451 (p<0.05).

By measuring hsTnI in urine and determining the difference between healthy and those with hypertension, a new diagnostic test for hypertension monitoring and detection would be obtained.

Key words: troponin I, urin, hypertension

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Can first trimester placental biomarkers copeptin and PP13 predict preeclampsia in advanced age nulliparous women?


Preeclampsia (PE) affects approximately 3% of all pregnancies and it is still a major cause of adverse perinatal outcome. PE is a multisystem pregnancy related disorder of unknown aetiology with a progressive course and with no established therapy. In recent times excessive research was conducted on early screening for PE with an aim to reduce the prevalence of the disease with early medical treatment starting from the first trimester of pregnancy in the high-risk group. The aim of this study is to detect if the first trimester serum copeptin and PP13 can predict preeclampsia in advanced age nulliparous women. These are the preliminary results of an ongoing prospective study that will include 400 pregnant women undergoing first trimester aneuploidy screening at the Department for Obstetrics and Gynaecology, University Hospital Centre Zagreb. Maternal risk factors used as inclusion criteria in this study were: nulliparity and age >35. Participants were asked to complete a short questionnaire regarding personal and medical information. Blood samples were collected and maternal serum PP13 and copeptin levels were measured. Following the inclusion criteria, we analysed the records of 40 women who gave birth to this date. Three patients (7.5%) developed preeclampsia and eight (20%) had gestational hypertension (GH). All PE patients had elevated plasma copeptin. Our preliminary data suggests that early screening for PE at 11-13 weeks of gestation using biomarkers copeptin and PP-13, in combination with maternal risk factors, is by far the most promising method for early detection of PE in advanced age nulliparous women.

Key words: preeclampsia, biomarkers, copeptin, high-risk pregnant women

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